State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome

Kroelinger, Charlan D.; Rice, Marion E.; Cox, Shanna; Hickner, Hadley R; Weber, Mary Kate; Romero, Lisa; Ko, Jean Y.; Addison, Donna; Mueller, Trish; Shapiro-Mendoza, Carrie K.; Fehrenbach, S. Nicole; Honein, Margaret A.; Barfield, Wanda D.

doi:10.15585/mmwr.mm6836a1

Cited by 41 publications

(33 citation statements)

References 9 publications

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“…[58] Affected groups include childbearing women and prenatally exposed infants, [59] those at-risk for or with a history of incarceration [60], homeless people, [48] and people living with chronic pain [55,56]. As responses to the opioid epidemic scale-up to address effects of lack of insurance, training of prescribers can help them to distinguish medical needs from situations in which opioids are likely to be diverted for non-medical use.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

et al. 2020

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BackgroundUnderstanding relationships between individual-level demographic, socioeconomic status (SES) and U.S. opioid fatalities can inform interventions in response to this crisis. MethodsThe Mortality Disparities in American Community Study (MDAC) links nearly 4 million 2008 American Community Survey responses to the 2008-2015 National Death Index. Univariate and multivariable models were used to estimate opioid overdose fatality hazard ratios (HR) and 95% confidence intervals (CI).

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Section: Discussionmentioning

confidence: 99%

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

et al. 2020

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“…The purpose of the OMNI LC, a type of learning collaborative, is to disseminate strategies and best practices that support state programs and policies on OUD among these vulnerable populations. 67 The Learning Community provides a framework or structure for states to develop actionable plans supporting program or policy systems change. CDC and other federal partners collaborate with ASTHO in implementing the OMNI LC by providing technical assistance (TA) such as up to date information on opioid surveillance and programmatic opportunities that can be leveraged for success.…”

Section: Public Health Laws and Policiesmentioning

confidence: 99%

“…69,71,74 The OMNI LC includes these components and requires multidisciplinary, multiagency state teams to participate in in-person meetings and virtual learning events 68 to implement systems change activities targeting OUD among pregnant and postpartum women and prenatal opioid exposure in infants. 67 To implement the OMNI LC, ASTHO partnered with a wide range of agencies and organizations, developed clear criteria for selecting states to participate in the activity, and identified core state team members critical for systems change. To provide states with timely and accurate national programmatic updates, ASTHO invited CDC, other federal agencies, and clinical and nonclinical membership organizations to participate in OMNI LC activities and engage in partner update meetings (Table 1).…”

Section: Using the Learning Collaborative Model As A Mechanism For Symentioning

confidence: 99%

Implementing a Learning Collaborative Framework for States Working to Improve Outcomes for Vulnerable Populations: The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community

Kroelinger

Addison

Rodriguez

et al. 2020

Journal of Women's Health

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The opioid crisis has impacted vulnerable populations, specifically pregnant and postpartum women, and infants prenatally exposed to substances, including infants with Neonatal Abstinence Syndrome. Lack of access to clinical and social services; potential stigma or discrimination; and lack of resources for provision of services, including screening and treatment, have impacted the health of these populations. In 2018, using a systems change approach, the Association of State and Territorial Health Officials (ASTHO) and the Centers for Disease Control and Prevention (CDC) convened an Opioid use disorder, Maternal outcomes, Neonatal abstinence syndrome Initiative Learning Community (OMNI LC) that included other federal agencies, national clinical and nonclinical organizations, and 12 state leadership groups. The purpose of the OMNI LC was to determine areas of focus and identify strategies and best practices for implementing systems change to improve maternal and infant outcomes associated with opioid use disorder (OUD) during the perinatal period. Activities included inperson convenings with policy goal action plan development, virtual learning sessions, intensive technical assistance (TA), and temporary field placements. The OMNI LC partnering agencies and state teams met bimonthly for the first year of the initiative. At the in-person convening, state teams identified barriers to developing and implementing systems change in activity-specific action plans within five areas of focus: financing and coverage; access to and coordination of quality services; provider training and awareness; ethical, legal, and social considerations; and data, monitoring, and evaluation. State teams also identified stakeholder partnerships as a necessary component of strategy development in all areas of focus. Four virtual learning sessions were conducted on the areas of focus identified by state teams, and ASTHO conducted three intensive TA opportunities, and five states were identified for temporary field placement. To successfully address the impact of the opioid crisis on pregnant and postpartum women and infants, states developed innovative strategies focused on increasing support, services, and resources. Moving forward, state teams will participate in two additional in-person meetings, continue to identify barriers to the work, refine and customize action plans, and set new goals, to effect broad-ranging systems change for these vulnerable populations.

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“…The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community is one example of public health efforts to address discontinuity of care. States teams participating in this collaborative are composed of state Medicaid medical director, behavioral, mental health, or alcohol and drug abuse director, Title V director, and a provider or facility champion (28). These state teams are working to implement strategies such as: development of a MAT provider network map for pregnant and postpartum women with OUD, implementation of a care bundle to address OUD, and waiving prior authorization prescribing requirements for MAT (28) Furthermore, state or regional perinatal quality collaboratives (multidisciplinary state or regional teams composed of obstetriciangynecologists, neonatologists, pediatricians, hospital leaders, patient representatives, and community organizations) may be useful in standardizing protocols that promote continuous care for pregnant and postpartum women and their infants across hospitals and outpatient clinics.…”

Section: Commentmentioning

confidence: 99%

“…Several states are exploring strategies to address the increased risk of overdose in the postpartum period and the need for continuity of care. These strategies include: providing and reimbursing integrated wraparound services for pregnant and postpartum women and their infants, and working with insurers, including Medicaid to ensure full insurance coverage up to 1 year postpartum (28). However, a study of MAT providers, opioid treatment programs, and outpatient buprenorphine providers in four Appalachian states found that opioid treatment programs were less likely to treat pregnant women and accept either Medicaid or private insurance (29).…”

Section: Commentmentioning

confidence: 99%

Obstetrician–gynecologists’ practice patterns related to opioid use during pregnancy and postpartum—United States, 2017

Tong

Haight

et al. 2019

J Perinatol

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Objective: To describe obstetrician-gynecologists' practices and attitudes related to opioid use among pregnant and postpartum women. Study Design: A 2017 cross-sectional survey assessed U.S. obstetrician-gynecologists' (n=462; response rate=34%) practices (management) and attitudes (knowledge, preparedness, confidence, barriers, and resources needed) related to opioid use among pregnant and postpartum women. Modified Poisson regression determined adjusted prevalence ratios (aPR) for advising medication assisted therapy (MAT) for pregnant women with opioid use disorder (OUD) by knowledge, confidence, and preparedness. Results: Of respondents, 33% usually or always advised MAT to pregnant women with OUD. Confidence in treating pregnant women who use opioids (aPR: 1.3, 95% CI: 1.0-1.8) and knowledge that substance use services were covered under the Affordable Care Act (aPR: 1.4, 95% CI: 1.1-1.8) were associated with advising MAT. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

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State Strategies to Address Opioid Use Disorder Among Pregnant and Postpartum Women and Infants Prenatally Exposed to Substances, Including Infants with Neonatal Abstinence Syndrome

Cited by 41 publications

References 9 publications

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

Socioeconomic risk factors for fatal opioid overdoses in the United States: Findings from the Mortality Disparities in American Communities Study (MDAC)

Implementing a Learning Collaborative Framework for States Working to Improve Outcomes for Vulnerable Populations: The Opioid Use Disorder, Maternal Outcomes, and Neonatal Abstinence Syndrome Initiative Learning Community

Obstetrician–gynecologists’ practice patterns related to opioid use during pregnancy and postpartum—United States, 2017

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