Barriers to Accessing Opioid Agonist Therapy in Pregnancy

Abstract: Background The incidence of opioid use disorder during pregnancy has risen dramatically in the last couple decades. Despite the safety and efficacy of treatment for opioid use during pregnancy, pregnant women often cannot access treatment. Objectives To determine the availability of opioid agonist therapy to pregnant women in Missouri and Illinois. To compare different markers of treatment accessibility between opioid treatment programs and buprenorphine providers and between rural and urban practices. Study Design Buprenorphine providers and opioid treatment programs in Missouri and Illinois were identified using the Substance Abuse and Mental Health Services Administration website. A phone audit was conducted to evaluate barriers to care, including whether clinics accepted new patients, pregnant patients, and insurance, as well as time to first appointment and appointment cost. Rural-Urban Commuting Area codes and practice ZIP codes were used to determine whether practice location was rural or urban. Provider specialty was determined from state licensing databases. Results There were 1,363 buprenorphine providers and 98 opioid treatment programs listed. Clinics were clustered around metropolitan areas, and only 13% (183/1,363) of buprenorphine providers and 5% (5/98) of opioid treatment programs were in rural areas. Despite three contact attempts for each clinic, we were unable to reach 42% (401/965) of buprenorphine providers and 14% (14/98) of opioid treatment programs. Of those reached, 40% (223/564) of buprenorphine providers and 80% (67/84) of opioid treatment programs were accepting new pregnant patients (p=0.01). Buprenorphine providers required more contact attempts (more than 2 attempts in 34% vs 15%, p Conclusion This is the first phone audit to evaluate access to opioid agonist therapy for pregnant women. Only a minority of buprenorphine providers offered care for this patient population, and a large proportion required multiple contact attempts and wait times longer than 7 days. Opioid treatment programs were more responsive and accepting of new pregnant patients but comprised a minority of clinics and were predominately located in urban areas. There is an urgent need for improved reliability of contact information for opioid agonist providers, timely intake and acceptance for treatment of pregnant patients, and overall improved access to clinics that are challenged by geographic and insurance status barriers.