Research Report: In Appalachia, Pregnant Women With OUD Encounter Barriers to Treatment

September 4, 2018

By Barbara Goodheart, ELS

Appalachia is an area long known for beautiful scenery, coal mining, and devastating poverty. And now the area around central Appalachia has become the epicenter of the opioid epidemic.

Four Appalachian states—Tennessee, Kentucky, North Carolina, and West Virginia—have been especially hard-hit in the epidemic. A team from Vanderbilt University in Nashville launched a study to investigate possible barriers to treatment in women with opioid use disorder (OUD). A report of their findings, summarized below, was published online June 27 in Substance Abuse.

The Study

Between April and May of 2017, the Vanderbilt team conducted a phone survey of opioid agonist treatment (OAT) providers, opioid treatment programs (OTPs), and providers of buprenorphine outpatient services, in the four Appalachian states.

They wanted to learn if insurance and pregnancy status had become barriers to treatment for women in states especially hard-hit by the opioid epidemic.

It became clear to the team that some women seeking treatment were coming up against barriers—even stigma. Some barriers varied by location; others by type of payment; still others by type of treatment: methadone or buprenorphine. Two groups were especially affected: pregnant women, and women who wanted to pay using insurance instead of cash.

Medicaid acceptance ranged from 83% in West Virginia to only 14% in Tennessee.

Even though the area was disproportionately impacted by the opioid epidemic, many OTPs and buprenorphine providers didn’t accept any insurance, and buprenorphine providers treated a smaller percentage of women who were pregnant.

The research team had noted earlier the effectiveness of opioid agonist therapies in OUD, especially for pregnant women, and had emphasized that “improving access to OAT is an urgent public policy goal.”

On viewing the results of their survey, the Vanderbilt research team had two suggestions to help bring this about.

First, enhance access to treatment by prioritizing improvements in provider training. For example, obstetricians could be trained to become buprenorphine prescribers. Second, improve providers’ acceptance of insurance by raising reimbursement rates.

The study was funded by a grant from the National Institute on Drug Abuse, National Institutes of Health.