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Increasing the Reach and Impact of Opioid Treatment and Recovery Programs Before and After Birth

By: Henry Larweh

July 19, 2023

Core Strategies Three and Four of Exhibit E, and outlined in the Primer on Spending Funds from the Opioid Litigation, recommend that states and local jurisdictions allocate a part of settlement funds towards treatment and recovery services tailored for neonatal care and for people who are pregnant and parents. Increasing access to these services will help reduce the risk for adverse health outcomes associated with opioid use disorder. The CDC provides recommendations for treating pregnant persons for opioid use disorder (OUD) both during and after pregnancy.

Barriers and Concerns for Treatment

Providing care with buprenorphine and methadone improves the health outcomes for pregnant persons with OUD and their infants. Despite this, people with OUD who are pregnant often fear social and legal repercussions if they were to seek treatment, decreasing how likely they are to receive evidence-based care. Additionally, people who are pregnant are less likely to receive treatment with methadone or buprenorphine than people who aren’t pregnant.  Black women, who already face poorer outcomes during pregnancy, are even less likely to seek and receive methadone or buprenorphine for their OUD and are limited in their treatment options. These barriers are likely due to the combined effects of systemic racism in healthcare and the unwillingness of healthcare providers to provide treatment of OUD to seeking pregnant persons.

Example Programs and Interventions

The West Virginia Department of Health and Human Resources, in collaboration with other state agencies, launched the Drug Free Moms and Babies Project (DFMB) to provide maternal care and supports to pregnant persons experiencing OUD. Using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) process, the project combines medical and behavioral healthcare with a community healthcare model to reach communities across West Virginia. Initial analysis of the project showed that pregnant persons who completed the program in their communities and used services offered at Drug Free Moms and Babies Project sites experienced improved outcomes, including lower preterm birth rates as compared to West Virginia’s average rate (8.1% v.s. 12.6%) and an increase in negative drug screening results among program participants from the beginning of pregnancy until delivery. Still, the Drug Free Moms and Babies Project project is constantly evolving and trying out new methods to increase its impact and support for pregnant persons with OUD.

New Jersey’s Department of Children and Families offers assistance and resources to anyone who is pregnant and their infant(s), as well as a plan of safe care for any pregnant person with OUD. This non-punitive approach aims to connect people with resources and care to support their health and wellness during their pregnancy and postpartum period. Pregnant persons and those who are planning to have children are encouraged to contact the Department of Children and Families to receive resources before giving birth.

Recommendations for States and Jurisdictions

States and jurisdictions should evaluate their existing treatment and recovery structures to ensure that there are appropriate services for people before, during, and after their pregnancy. This assessment should ensure that racial equity is prioritized in the makeup of these programs (Principle 4). After conducting this needs assessment, jurisdictions should consider using settlement funds to either improve or create new services tailored to the needs of people who are pregnant. Policy and practice changes to improve access to buprenorphine and methadone may also be needed for states and jurisdictions to see significant reductions of overdose incidence and prevalence of OUD among people who are pregnant.