Factors associated with prescription opiate use among pregnant women enrolled in Medicaid

Background. While previous research details rising economic and health costs associated with non-medical use of prescription opiates among women, little is known about the scope of the problem among pregnant women, despite the potential maternal and fetal risks.  This study explores the prevalence of maternal opioid use among South Carolina Medicaid recipients and associated demographics among women who had a delivery in 2010 and were prescribed an opiate during 2009-2011.

Methods. Opioid National Drug Codes were pulled from the Opioid Medication Use Evaluation software.  A subset of women ages 18-34 who had an opioid drug claim and a baby was created from Medicaid claims data; age, race, eligibility, rural/urban, emergency room (ER) utilization, and mental health status were compared.  Descriptive statistics and chi-square tests were used to analyze the data. 

Results. Of 104,069 women who were prescribed opioids, 26.8% had a delivery (n=22,016).  Pregnant women were more likely ages 18-25 (64.38%), white/Caucasian (48.76%), part of a pregnancy/family eligibility group (91.43%), and from an urban area (67.76%).  21.56% had a mental health diagnosis, and 69.22% had visited the ER.  The relationship between these variables and opiate use was significant (p = <.0001).              

Conclusions. These data suggest the need for changes in service delivery that promote early identification of opioid-dependent pregnant women among client-risk groups, which is key to improving both maternal and infant outcomes, as well as reducing overall cost to state agencies resulting from high ER utilization, neonatal intensive care unit costs, prescription monitoring, medical complications, and treatment.