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

摘要： 当前的新冠肺炎疫情给个人和医疗保健带来了许多挑战 美国的系统。更糟糕的是，大流行发生在 怀孕期间阿片类药物使用障碍和过量的公共卫生危机。2010年至 2017年，孕产妇阿片类药物相关诊断发病率从3.5‰上升到8.2‰ 每年在医院出生的活产儿。母亲在怀孕期间使用阿片类药物与增加 长时间住院、胎盘早剥、胎儿发育不良、早产、 早产、死产、新生儿禁欲综合症和产妇死亡。状态 新冠肺炎大流行前孕妇孕期使用阿片类药物的反应 有很大的不同，包括：1)建立资助的药物治疗方案 对于孕妇，2)优先获得国家资助的治疗方案，3)强制 医疗保健专业人员的报告和药物筛选，以及4)将阿片类药物使用定为刑事犯罪 在怀孕期间或承诺的理由。然而，这些政策不太可能继续下去 静止的，特别是在当前的新冠肺炎大流行期间。对社交距离的需求导致了 到与阿片类药物使用障碍的治疗有关的政策变化，如缓解 美沙酮配药规则和使患者更容易启动丁丙诺啡 从阿片类药物治疗中心接受治疗。然而，这些变化并不是强制性的，而且 在获得药物辅助治疗(MAT)方面的系统级收益可能会随着 大流行消退了。此外，人们对政策在多大程度上与 在新冠肺炎大流行期间，孕妇在怀孕期间使用阿片类药物的情况正在发生变化 这些变化对妇幼保健治疗、结果和 成本。因此，这项研究的目的是：1)考察国家政策如何与产妇 怀孕期间阿片类药物的使用因新冠肺炎大流行而发生变化，以及2) 审查与新冠肺炎相关的国家阿片类药物使用政策变化的影响 关于医疗服务使用模式、孕产妇和儿童结局以及医疗费用。通过 彻底检查针对新冠肺炎大流行的政策应对措施，并将这些数据 描述使用阿片类药物的妇女的医疗服务使用情况的详细索赔数据 我们将能够向服务提供者、保险公司、 卫生系统和政策制定者在设计治疗流程和政策时提供 对这一弱势群体进行适当的怀孕和药物使用护理，以缓解这两种情况 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.