COVID-19, health systems and vulnerable populations: Policies affecting maternal opioid use during pregnancy

摘要： 当前的COVID-19大流行为个人和医疗保健带来了许多挑战 系统在美国。更糟糕的是，这一流行病发生在 阿片类药物使用障碍和怀孕期间过量的公共卫生危机。在2010年至 2017年，母体阿片类药物相关诊断的发生率从每1000人3.5人增加到8.2人 每年住院分娩。妊娠期间母体使用阿片类药物与增加 住院时间延长、胎盘脱垂、胎儿生长不良、早产的风险， 早产、死产、新生儿禁欲综合症和产妇死亡。状态 关于COVID-19大流行前孕妇在怀孕期间使用阿片类药物的回应 有很大的不同，包括：1）建立资助的药物治疗计划，特别是 孕妇，2）优先获得国家资助的治疗方案，3）强制性 医疗保健专业人员的报告和药物筛查，以及4）将阿片类药物使用定为刑事犯罪 怀孕期间或承诺的理由。然而，这些政策不太可能持续下去。 静态，尤其是在当前的COVID-19大流行期间。社交距离的需要导致了 与阿片类药物使用障碍治疗有关的政策变化，如放松 美沙酮配药规则，使病人更容易开始丁丙诺啡 阿片类药物治疗中心。这些变化不是强制性的， 在获得药物辅助治疗（MAT）方面的系统级收益可能会被消除， 大流行平息。此外，人们对政策在多大程度上涉及 在COVID-19大流行期间，孕妇在怀孕期间使用阿片类药物正在发生变化， 这些变化对孕产妇和儿童保健治疗、结果和 成本因此，本研究的目的是：1）检查国家政策如何与孕产妇相关 怀孕期间阿片类药物的使用因COVID-19大流行而发生变化，以及2） 检查与COVID-19相关的国家政策变化对孕产妇使用阿片类药物的影响 关于医疗服务使用模式、母婴结局和医疗费用。通过 彻底审查对COVID-19大流行的政策反应，并将这些数据联系起来 详细的索赔数据描述了在治疗期间使用阿片类药物的妇女的医疗保健服务使用情况 怀孕和新生儿，我们将能够提供关键数据的供应商，保险公司， 卫生系统和决策者，因为他们设计的治疗过程和政策， 为这一弱势群体提供适当的怀孕和药物使用护理， 公共卫生危机。

Abstract: The current COVID-19 pandemic creates many challenges for individuals and health care systems in the United States. To make matters worse, the pandemic is occurring in the midst of a public health crisis of opioid use disorder and overdose during pregnancy. Between 2010 and 2017, the incidence of maternal opioid-related diagnoses increased from 3.5 to 8.2 per 1000 hospital live births per year. Maternal opioid use during pregnancy is associated with increased risks of prolonged hospital stay, placental abruption, poor fetal growth, preterm labor, premature delivery, stillbirth, neonatal abstinence syndrome, and maternal death. State responses regarding maternal opioid use during pregnancy prior to the COVID-19 pandemic have varied widely and included: 1) creation of funded drug-treatment programs specifically for pregnant women, 2) priority access to state-funded treatment programs, 3) mandated reporting and drug screening by healthcare professionals, and 4) criminalization of opioid use during pregnancy or grounds for commitment. However, these policies are unlikely to remain static, especially during the current COVID-19 pandemic. The need for social distancing has led to policy changes related to treatment of opioid use disorder more generally, such as easing methadone dispensing rules and making it easier for patients to initiate buprenorphine treatment from an opioid treatment center. These changes are not mandatory, however, and system-level gains in access to medication assisted treatment (MAT) may be eliminated as the pandemic subsides. In addition, little is known about the extent to which policies related to maternal opioid use during pregnancy are changing during the COVID-19 pandemic, or the extent to which such changes affect maternal and child healthcare treatment, outcomes and costs. Thus, the aims of this study are to 1) examine how state policies related to maternal opioid use during pregnancy have changed in response to the COVID-19 pandemic, and 2) examine the effects of COVID-19-related changes in state policies regarding maternal opioid use on patterns of healthcare service use, maternal and child outcomes, and healthcare costs. By thoroughly examining the policy responses to the COVID-19 pandemic and linking these data to detailed claims data describing healthcare service use of women who use opioids during pregnancy and their newborns, we will be able to provide critical data to providers, insurers, health systems, and policymakers as they design treatment processes and policies to provide adequate pregnancy and substance use care to this vulnerable population to mitigate these two public health crises.