Hospitalizations for opiate abuse among women of childbearing age -- Illinois, 2010-2013

Background:
Opiate abuse is steadily increasing in the US and is now the leading cause of injury death, and of hospitalization due to drug abuse.  Abuse among women of childbearing age carries significant risks both to the woman and to her family, including birth defects and neonatal abstinence syndrome.  Increasingly, opiate abuse is occurring in rural communities that may lack experience and resources to address the needs of these patients.

Methods:
We analyzed the Illinois hospital discharge data set and identified women of childbearing age (age 15-44) who had a primary diagnosis of opiate abuse from 2010-2013.  We included codes for dependence, abuse or poisoning by prescription opiates, heroin or opium.  We examined both inpatient hospitalizations and outpatient visits to emergency rooms (ERs).  We analyzed visits by sociodemographic characteristics and compared rates of visits between groups using the t test.

Results:
The number of discharges ranged from 2884 in 2010 to 3254 in 2012.  The average yearly rate was 117.4 visits per 100,000 population.  Over half of the visits, 55.7%, were outpatient visits to ERs, and the percentage of patients receiving outpatient care increased during the study period, from 50.8% in 2010 to 60% in 2013.  White women (144.2 visits per year per 100,000 population), and women age 30 to 34 (159 visits/100000) had a significantly higher rates of hospital visits (p<.05).  Rates were nearly three times higher in the rural counties (296.7 visits 100000 population) than in urban Cook County (95.7 visits/100000, p<.05).  Almost 30% of outpatient visits were among patients with no health insurance, and 36% of outpatient visits and 35% of inpatient hospitalizations were among Medicaid patients.

Conclusions:
Opiate abuse results in thousands of ER visits and hospitalizations among women of childbearing age.  In Illinois, some groups experience disparities in opiate abuse, including white women and women in rural communities.  Discharges for opiate abuse are common among uninsured women and women with Medicaid and likely present a significant financial burden to these patients.  Increasingly, opiate abuse is being handled by Illinois’s emergency rooms, presenting a possible opportunity to increase access to outpatient treatment options and integration with primary care providers.  Efforts to address opiate abuse in Illinois must address resource constraints of rural communities.