Polysubstance Use Among Pregnant Women With Opioid Use Disorder in the United States, 2007–2016

Source:

Jarlenski, M. P., Paul, N. C., & Krans, E. E. (2020). Polysubstance Use Among Pregnant Women With Opioid Use Disorder in the United States, 2007-2016. Obstetrics and gynecology, 136(3), 556–564. https://doi.org/10.1097/AOG.0000000000003907

Abstract

Objective:

To assess trends in polysubstance use among pregnant women with opioid use disorder in the United States.

Methods:

We conducted a time trend analysis of pooled, cross-sectional data from the National Inpatient Sample, an annual nationally representative sample of US hospital discharge data. Among 38.0 million females aged 15–44 years with a hospitalization for delivery from 2007 to 2016, we identified 172,335 pregnant women with an ICD-9 or ICD-10 diagnosis of opioid use disorder. Polysubstance use among pregnant women with opioid use disorder was defined as ≥1 co-occurring diagnosis of other substance use, including alcohol, amphetamine, cannabis, cocaine, sedative, or tobacco. We fit weighted multivariable logistic regression models to produce nationally representative estimates, including an interaction between year and rural vs. urban county of residence; controlled for age, race, and insurance type. Average predicted probabilities and 95% CIs were derived from regression results.

Results:

Polysubstance use among women with opioid use disorder increased from 60.5% (95% CI: 58.3%, 62.8%) to 64.1% (95% CI: 62.8%,65.3%). Differential time trends in polysubstance use among women with opioid use disorder were found in rural versus urban counties. Large increases in amphetamine use occurred among those in both rural and urban counties (255.4%; 95% CI: 90.5%,562,9% and 150.7%; 95% CI: 78.2%,252.7%, respectively), similarly to tobacco use (30.4%; 95% CI: 16.9%,45.4% and 23.2%; 95% CI: 15.3%,31.6%, respectively). Cocaine use diagnoses declined among women with opioid use disorder at delivery among those in rural (−70.5%; 95% CI: −80.4%,−55.5%) and urban (−61.9%; 95% CI: −67.6%,−55.1%) counties. Alcohol use diagnoses among those with opioid use disorder declined −57% (95% CI: −70.8%,−37.7%) among those in urban counties but did not change among those in rural counties.

Conclusion:

Over the past decade, polysubstance use among pregnant women with opioid use disorder has increased more rapidly in rural versus urban counties in the U.S., with amphetamines and tobacco use increasing most rapidly.