Substance use and treatment characteristics among pregnant and non-pregnant females, 2015-2019.

INTRODUCTION: In the United States (US), pregnant females who use substances face increased morbidity and mortality risks compared to non-pregnant females. This study provides a national snapshot of substance use and treatment characteristics among US reproductive-aged females, including those who are pregnant. METHODS: Our sample included females aged 15-44 years (n=97,830) from the 2015-2019 National Survey on Drug Use and Health (NSDUH) data. We calculated weighted percentages of past-month alcohol or drug use and past-year substance use disorder (SUD), stratified by pregnancy status. We also calculated weighted percentages of past-year treatment setting and payer. Pearson chi-square tests were conducted to determine if percentages were statistically significantly different. RESULTS: Compared to non-pregnant females, pregnant females had lower prevalence of past-month illicit drug use excluding cannabis (1.6% vs. 4.3%, p<0.01), cannabis use (5.3% vs. 12.5%, p<0.01), binge drinking (4.5% vs. 29.3%, p<0.01) and past-year SUD (7.1 vs. 8.8%, p<0.01). Less than 13% of females with SUD received treatment regardless of pregnancy status, but treatment use was higher among pregnant females compared to non-pregnant females (12.8% vs. 10.5%). However, there were no statistically significant differences in past-year treatment use, setting, or treatment payer. DISCUSSION: The prevalence of substance use and SUD was lower among pregnant females compared to non-pregnant females in 2015-2019. Low uptake of substance use treatment suggests that barriers exist to treatment-seeking among reproductive-aged women. Further exploration of stigma, payment, and access to treatment, and how they differ by pregnancy status, is needed.

Expanding buprenorphine in U.S. jails: One county's response to addressing the fears of diversion.

INTRODUCTION: The overdose crisis continues to be a major public health emergency in the United States. While effective medications for opioid use disorder (MOUD), such as buprenorphine, have ample scientific evidence to their effectiveness, they are underutilized in the United States and particularly in criminal justice settings. One rationale against the expansion of MOUD in carceral settings cited by jail, prison, and even Drug Enforcement Administration leaders is the potential for diversion of these medications. However, currently little data exist to support this claim. Instead, successful examples from early expansion states could help to change attitudes and calm misconceptions around diversion fears. RESULTS: In this commentary, we discuss the experience of one county jail that successfully expanded buprenorphine treatment and did not suffer significant impacts related to diversion. Instead, the jail found that their holistic and compassionate approach to buprenorphine treatment improved conditions both for incarcerated individuals and jail staff. CONCLUSION: Amid a changing policy landscape and a federal commitment to increase access to effective treatments in criminal justice settings, lessons can be learned from jails and prisons that have already or are working toward expansion of MOUD in their facilities. Ideally, these anecdotal examples, in addition to data, will help to encourage more facilities to incorporate buprenorphine into their opioid use disorder treatment strategies.

The effects of the Maryland Medicaid Health Home Waiver on Emergency Department and inpatient utilization among individuals with serious mental illness.

OBJECTIVE: The Maryland Medicaid health home program, established through the Affordable Care Act's Medicaid health home waiver, integrates primary care services into specialty mental health programs for adults with serious mental illness (SMI). We evaluated the effect of this program on all-cause, physical, and behavioral health emergency department (ED) and inpatient utilization. METHOD: Using marginal structural modeling to control for time-invariant and time-varying confounding, we analyzed Medicaid administrative claims data for 12,232 enrollees with SMI from October 1, 2012 to December 31, 2016; 3319 individuals were enrolled in a BHH and 8913 were never enrolled. RESULTS: Health home enrollment was associated with reduced probability of all-cause (PP: 0.23 BHH enrollment vs. 0.26 non-enrollment, p < 0.01) and physical health ED visits (PP: 0.21 BHH enrollment vs. 0.24 non-enrollment, p < 0.01) and no effect on inpatient admissions per person-three-month period. CONCLUSION: These results suggest the Maryland Medicaid health home waiver's focus on supporting physical health care coordination by specialty mental health programs may be preventing ED visits among adults with SMI, although effect sizes are small.