VCU news

By Dedrain Davis

While treatment rates in Virginia for pregnant Medicaid members with substance use disorder have increased, there are persistent racial inequities in addiction treatment, according to a new report from a team of faculty members at the Virginia Commonwealth University School of Medicine.

The team, which evaluates the state’s Addiction and Recovery Treatment Services program, released its report this week examining the diagnosis and treatment of substance use disorder among pregnant women enrolled in Medicaid.   

Virginia implemented the Addiction and Recovery Treatment Services program in 2017 to increase access to treatment for Medicaid members with opioid or other substance use disorders. In the past year, about 60,000 Virginians have received assistance from the program. Medicaid expansion in 2019 increased the number of low-income Virginians with addiction disorders who have access to the ARTS program. 

Peter Cunningham, Ph.D., a professor in the VCU School of Medicine’s Department of Health Behavior and Policy, leads the evaluation team and was assisted in this latest report by Erin Britton, a doctoral student in the Department of Health Behavior and Policy. Cunningham spoke with VCU News about the team’s latest findings. 

What did the latest report find?

The top findings would be that about 1 in 10 pregnant women who are enrolled in Medicaid have a diagnosis of substance use disorder in the 12 months prior to their delivery. Additionally, treatment rates for pregnant Medicaid members diagnosed with opioid use disorder rose from 58% to 76% between January 2017 and December 2018. This overlaps with the start of the ARTS program, so it suggests that access to treatment increased because of ARTS.

Another timely finding is that we found some severe racial disparities around whether pregnant women with substance use disorders were getting treatment.

The treatment rate for black women was 20% compared to 44% for white women. That means black women were less than half as likely to receive treatment when they had a diagnosis of a substance use disorder compared to white women. Moreover, these disparities exist across all Virginia regions, and were not explained by differences in age or length of time enrolled in Medicaid.There's a lot more to learn and understand about the racial disparity because it appears that substance use disorders are also underdiagnosed among black women compared to white women. This conflicts with national data showing that prevalence among women of childbearing age is roughly the same between both groups. There are concerns that stigma and child welfare actions triggered by the mother’s addiction problems could be discouraging many from getting treatment.

What does this mean for the treatment of substance use disorder in Virginia?

Overall, the treatment rates have been increasing since the ARTS program was started in the first quarter of 2017. This means that more pregnant women are getting access to treatment when they have a diagnosis of a substance use disorder. 

We know that pregnant women with substance use disorders have higher rates of preterm labor, stillbirths and higher maternal mortality. We're hoping that with the increased access to treatment there will be a reduction in these adverse outcomes.

How is this data gathered and evaluated?

For this particular study, it's based on analysis of Medicaid administrative claims. Every time a doctor bills Medicaid for a service they provide, it generates a record and that record has certain data that we study, such as conditions and type of services provided. In other evaluations we conduct surveys where we hear from people about their experiences with getting these services and how it's been helping them.

What else do you hope to learn in the evaluation of the ARTS program?

We’d like to extend the analysis to include the postpartum period, to understand the extent to which addiction and treatment continues following the delivery. Now that we're seeing higher rates of treatment, we also want to understand whether that treatment is resulting in better outcomes for women, as well as for their newborn babies. Rates of neonatal abstinence syndrome have been increasing in recent years as the opioid crisis has worsened, so ultimately, we would like to see that increased access to treatment results in better delivery and birth outcomes.