Literature Collection

BACKGROUND: Pregnant women and their unborn children are often overlooked in the opioid crisis, despite increased rates of both maternal complications and neonatal opioid withdrawal syndrome. Although medications for opioid use disorder (MOUD) are considered the gold standard for pregnant women, many either do not have access to or are not offered MOUD as an option. OBJECTIVES: To describe the characteristics of MOUD care models and assess the effectiveness of MOUD Care Models on initiation, adherence, and engagement in treatment for pregnant women with OUD. DATA SOURCES: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol directed the process of this scoping review. A search for English, peer-reviewed, quantitative studies, published between 2012 and 2023 was conducted in eight scholarly databases. The Joanna Briggs Critical Appraisal tools were used to assess study quality. CONCLUSIONS: The integrated care models included medication management, psychotherapy support, behavioral health care, and medical care management, with added focus on prenatal and postpartum care. Synthesis revealed that treatment engagement, medication adherence, breastfeeding rates, and postdelivery MOUD referrals were higher in integrated care models compared with nonintegrated care models. Pregnant women with OUD in integrated care models have better outcomes compared with those in nonintegrated care models. IMPLICATIONS FOR PRACTICE: Improvements in care models are necessary to tackle provider shortages, stigma, and financial, geographic, and technological barriers. Addressing these issues will enhance nurse practitioners' ability to provide comprehensive and accessible care to this vulnerable population.

BACKGROUND AND AIMS: Expanding access to medication-assisted treatment with buprenorphine is a cornerstone of the opioid crisis response, yet buprenorphine remains underutilized. Research has identified multiple barriers to prescribing buprenorphine. This study aimed to examine clinician characteristics, prescribing practices and barriers and incentives to prescribing buprenorphine among clinicians with a federal Drug Addiction Treatment Act of 2000 (DATA) waiver to prescribe buprenorphine for opioid use disorder treatment. DESIGN: Electronic survey of 4225 clinicians conducted between March and April 2018. SETTING: United States. PARTICIPANTS: Clinicians obtaining an initial federal DATA waiver or an increase in authorized patient limit to prescribe buprenorphine for opioid use disorder treatment in 2017. MEASUREMENTS: Descriptive statistics and multivariable logistic regression examined clinician characteristics, prescribing practices and primary barriers and incentives to prescribing buprenorphine or prescribing at or near the authorized patient limit. FINDINGS: Among respondents, 75.5% had prescribed buprenorphine since obtaining a DATA waiver; the mean (standard deviation) number of patients treated in the past month was 26.6 (40.3), and 13.1% of providers were prescribing at or near their patient limit in the past month. Lack of patient demand, cited by 19.4% of clinicians, was the most common primary barrier to prescribing buprenorphine or prescribing to the authorized patient limit, followed by time constraints in practice (14.6%) and insurance reimbursement, prior authorization or other insurance requirements (13.2%). Increased patient demand (22.2%), institutional support for buprenorphine treatment (12.5%) and increased reimbursement (12.2%) were the most endorsed primary incentives for buprenorphine prescribing. Multivariable logistic regression models identified multiple clinician characteristics associated with buprenorphine prescribing and prescribing at or near the authorized patient limit. CONCLUSIONS: US clinicians recently waivered to prescribe buprenorphine for opioid use disorder treatment appear to prescribe well below their patient limit, and many do not prescribe at all.

Background: Opioid use has disproportionally impacted pregnant people and their fetuses. Previous studies describing opioid use among pregnant people are limited by geographic location, type of medical coverage, and small sample size. We described characteristics of a large, diverse group of pregnant people who were enrolled in the Environmental Influences on Child Health Outcomes (ECHO) Program, and determined which characteristics were associated with opioid use during pregnancy. Materials and Methods: Cross-sectional data obtained from 21,905 pregnancies of individuals across the United States enrolled in the ECHO between 1990 and 2021 were analyzed. Medical records, laboratory testing, and self-report were used to determine opioid-exposed pregnancies. Multiple imputation methods using fully conditional specification with a discriminant function accounted for missing characteristics data. Results: Opioid use was present in 2.8% (n = 591) of pregnancies. The majority of people who used opioids in pregnancy were non-Hispanic White (67%) and had at least some college education (69%). Those who used opioids reported high rates of alcohol use (32%) and tobacco use (39%) during the pregnancy; although data were incomplete, only 5% reported heroin use and 86% of opioid use originated from a prescription. After adjustment, non-Hispanic White race, pregnancy during the years 2010-2012, higher parity, tobacco use, and use of illegal drugs during pregnancy were each significantly associated with opioid use during pregnancy. In addition, maternal depression was associated with increased odds of opioid use during pregnancy by more than two-fold (adjusted odds ratio 2.42, 95% confidence interval: 1.95-3.01). Conclusions: In this large study of pregnancies from across the United States, we found several factors that were associated with opioid use among pregnant people. Further studies examining screening for depression and polysubstance use may be useful for targeted interventions to prevent detrimental opioid use during pregnancy, while further elucidation of the reasons for use of prescription opioids during pregnancy should be further explored.