TY - JOUR
KW - Buprenorphine/adverse effects/therapeutic use
KW - Cohort Studies
KW - Combined Modality Therapy
KW - Female
KW - Health Services Accessibility/organization & administration
KW - Humans
KW - Infant, Newborn
KW - Methadone/adverse effects/therapeutic use
KW - Narcotics/adverse effects/therapeutic use
KW - Opiate Substitution Treatment
KW - Opioid-Related Disorders/rehabilitation
KW - Pregnancy
KW - Pregnancy Complications/rehabilitation
KW - Prospective Studies
KW - Retrospective Studies
KW - Rural Health Services/organization & administration
KW - Rural Population
KW - Treatment Outcome
KW - Vermont
AU - M. Meyer
AU - A. Benvenuto
AU - D. Howard
AU - A. Johnston
AU - D. Plante
AU - J. Metayer
AU - T. Mandell
A1 - 
AB - BACKGROUND: The goal of this study was to determine whether improved access to medication assisted therapy in the general population, with improved coordination of ancillary services for pregnant women, improved perinatal outcomes in a nonurban area. METHODS: The cohort of women treated for opioid dependence during pregnancy with medication-assisted therapy and delivered at a single institution between 2000 and 2006 were retrospectively identified (n = 149 women; n = 151 neonates). Access to opioid agonist therapy for the general population was determined as the combined number of available treatment positions for medication-assisted therapy. Treatment during pregnancy (interim substitution therapy vs opioid treatment program) and pregnancy outcomes were noted from chart review. The primary outcome of trend of prenatal care indices and newborn birth weight over time was determined by Kendall's tau. RESULTS: As access to treatment in the general population expanded from 2000 to 2006, the number of women receiving treatment increased, the proportion of women receiving interim substitution therapy decreased (P < 0.001), gestational age at the initiation of treatment decreased (P < 0.001), and the proportion of women receiving treatment before pregnancy increased (P < 0.001). Infants delivered to mothers in a treatment program had improved birth weight z score compared with those receiving interim substitution therapy (P = 0.007). The proportion of infants discharged to the care of the mother and remaining in maternal care at 1 year improved both over time (P = 0.03; P = 0.004) and with treatment within a treatment program (P < 0.001; P = 0.004). CONCLUSIONS: Improved access to opioid agonist treatment programs for the general population in nonurban areas improves perinatal outcome and retention of maternal guardianship.
BT - Journal of addiction medicine
C5 - Opioids & Substance Use; Healthcare Disparities
CP - 2
CY - United States
DO - 10.1097/ADM.0b013e3182541933
IS - 2
JF - Journal of addiction medicine
N2 - BACKGROUND: The goal of this study was to determine whether improved access to medication assisted therapy in the general population, with improved coordination of ancillary services for pregnant women, improved perinatal outcomes in a nonurban area. METHODS: The cohort of women treated for opioid dependence during pregnancy with medication-assisted therapy and delivered at a single institution between 2000 and 2006 were retrospectively identified (n = 149 women; n = 151 neonates). Access to opioid agonist therapy for the general population was determined as the combined number of available treatment positions for medication-assisted therapy. Treatment during pregnancy (interim substitution therapy vs opioid treatment program) and pregnancy outcomes were noted from chart review. The primary outcome of trend of prenatal care indices and newborn birth weight over time was determined by Kendall's tau. RESULTS: As access to treatment in the general population expanded from 2000 to 2006, the number of women receiving treatment increased, the proportion of women receiving interim substitution therapy decreased (P < 0.001), gestational age at the initiation of treatment decreased (P < 0.001), and the proportion of women receiving treatment before pregnancy increased (P < 0.001). Infants delivered to mothers in a treatment program had improved birth weight z score compared with those receiving interim substitution therapy (P = 0.007). The proportion of infants discharged to the care of the mother and remaining in maternal care at 1 year improved both over time (P = 0.03; P = 0.004) and with treatment within a treatment program (P < 0.001; P = 0.004). CONCLUSIONS: Improved access to opioid agonist treatment programs for the general population in nonurban areas improves perinatal outcome and retention of maternal guardianship.
PP - United States
PY - 2012
SN - 1932-0620; 1932-0620
SP - 124
EP - 130
EP - 
T1 - Development of a substance abuse program for opioid-dependent nonurban pregnant women improves outcome
T2 - Journal of addiction medicine
TI - Development of a substance abuse program for opioid-dependent nonurban pregnant women improves outcome
U1 - Opioids & Substance Use; Healthcare Disparities
U2 - 22517450
U3 - 10.1097/ADM.0b013e3182541933
VL - 6
VO - 1932-0620; 1932-0620
Y1 - 2012
ER -