County-level neonatal opioid withdrawal syndrome rates and real-world access to buprenorphine during pregnancy: An audit ("secret shopper") study in Missouri
- PMID: 38380272
- PMCID: PMC10877162
- DOI: 10.1016/j.dadr.2024.100218
County-level neonatal opioid withdrawal syndrome rates and real-world access to buprenorphine during pregnancy: An audit ("secret shopper") study in Missouri
Abstract
Background: Amid rising rates of neonatal opioid withdrawal syndrome (NOWS) worldwide and in many regions of the USA, we conducted an audit study ("secret shopper study") to evaluate the influence of county-level buprenorphine capacity and rurality on county-level NOWS rates.
Methods: In 2019, up to three phone calls were made to buprenorphine prescribers in the state of Missouri (USA). County-level buprenorphine capacity was defined as the number of clinicians (across all specialties) accepting pregnant people divided by the number of births. Multivariable negative binomial regression models estimated associations between buprenorphine capacity, rurality, and county-level NOWS rates, controlling for potential confounders (i.e., poverty, unemployment, and physician shortages) that may correspond to higher rates of NOWS and lower rates of buprenorphine prescribing. Analyses were stratified using tertiles of county-level overdose rates (top, middle, and lowest 1/3 of overdose rates).
Results: Of 115 Missouri counties, 81(70 %) had no buprenorphine capacity, 17(15 %) were low-capacity (<0.5-clinicians/1,000 births), and 17(15 %) were high-capacity (≥0.5/1,000 births). The mean NOWS rate was 6.5/1,000 births. In Missouri counties with both the highest and lowest opioid overdose rates, higher buprenorphine capacity did not correspond to decreases in NOWS rates (incidence rate ratio[IRR]=1.23[95 %-confidence-interval[CI]=0.65-2.32] and IRR=1.57[1.21-2.03] respectively). Rurality did not correspond to greater NOWS burden in both Missouri counties with highest and lowest opioid overdose rates.
Conclusions: The vast majority of counties in Missouri have no capacity for buprenorphine prescribing during pregnancy. Rurality and lower buprenorphine capacity did not significantly predict elevated rates of NOWS.
Keywords: Buprenorphine access; Neonatal opioid withdrawal; Pregnancy; Rurality.
© 2024 The Authors.
Conflict of interest statement
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Figures
Similar articles
-
Pharmacy-related buprenorphine access barriers: An audit of pharmacies in counties with a high opioid overdose burden.Drug Alcohol Depend. 2021 Jul 1;224:108729. doi: 10.1016/j.drugalcdep.2021.108729. Epub 2021 Apr 24. Drug Alcohol Depend. 2021. PMID: 33932744
-
Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome.JAMA. 2019 Jan 29;321(4):385-393. doi: 10.1001/jama.2018.20851. JAMA. 2019. PMID: 30694320 Free PMC article.
-
A Descriptive Study on Opioid Misuse Prevalence and Office-Based Buprenorphine Access in Ohio Prior to the Removal of the Drug Addiction Treatment Act of 2000 Waiver.Cureus. 2023 Mar 30;15(3):e36903. doi: 10.7759/cureus.36903. eCollection 2023 Mar. Cureus. 2023. PMID: 37139287 Free PMC article.
-
Neonatal opioid toxicity: opioid withdrawal (abstinence) syndrome with emphasis on pharmacogenomics and respiratory depression.Arch Toxicol. 2023 Oct;97(10):2575-2585. doi: 10.1007/s00204-023-03563-8. Epub 2023 Aug 3. Arch Toxicol. 2023. PMID: 37537419 Review.
-
Opioid Treatment for Neonatal Opioid Withdrawal Syndrome: Current Challenges and Future Approaches.J Clin Pharmacol. 2021 Jul;61(7):857-870. doi: 10.1002/jcph.1811. Epub 2021 Feb 1. J Clin Pharmacol. 2021. PMID: 33382111 Review.
References
-
- ACOG, 2017. Committee Opinion 711: opioid Use and Opioid Use Disorder in Pregnancy. - PubMed
-
- Andraka-Christou B. Addressing Racial And Ethnic Disparities In The Use Of Medications For Opioid Use Disorder. Health Aff. 2021;40(6):920–927. - PubMed
-
- Banks D.E., Scroggins S., Paschke M.E., Shacham E., Nance M., Cavazos-Rehg P., Winograd R.P. Examining Increasing Racial Inequities in Opioid Overdose Deaths: a Spatiotemporal Analysis of Black and White Decedents in St. Louis, Missouri, 2011-2021. Journal of Urban Health-Bulletin of the New York Academy of Medicine. 2023;100(3):436–446. - PMC - PubMed
-
- Banta-Green C.J., Owens M.D., Williams J.R., Sears J.M., Floyd A.S., Williams-Gilbert W., Kingston S. The Community-Based Medication-First program for opioid use disorder: a hybrid implementation study protocol of a rapid access to buprenorphine program in Washington State. Addict Sci Clin Prac. 2022;17(1) - PMC - PubMed
-
- Bedrick B.S., O'Donnell C., Marx C.M., Friedman H., Carter E.B., Stout M.J., Kelly J.C. Barriers to accessing opioid agonist therapy in pregnancy. Am J Obst Gynec Mfm. 2020;2(4) - PubMed
Grants and funding
LinkOut - more resources
Full Text Sources