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Structural Factors Shape the Effects of the Opioid Epidemic on Pregnant Women and Infants — new editorial in @JAMA_current by @PublicHealthUMN policy professor @katybkoz and @umichmedicine OB/GYN @lindsayadmon. Full editorial: z.umn.edu/41rx Some highlights (thread) 1/
“Economic forces have shaped the course of the #opioidepidemic across the U.S., with a growing body of evidence documenting how local conditions like a struggling economy can exacerbate health crises, especially in rural counties.” 2/
“In rural counties, access to maternity care is declining in many of the same communities where there are fewer clinicians providing treatment for opioid use disorder.” 3/
“If the well-being of infants with opioid-affected births is a central concern, efforts to both study and address this crisis ought to begin with their mothers. This will require renewed efforts to prevent, detect, and treat opioid use disorders among childbearing women.” 4/
“First, prevention efforts must focus more broadly on reproductive-aged women, regardless of pregnancy status, which to date has not been a major priority for research or programmatic funding.” 5/
“Second, punitive laws in many states that discourage women from disclosing substance use during pregnancy must be amended.” 6/
“All major medical organizations that care for women have condemned punitive legislation [policing substance use during pregnancy] as being detrimental to women and society.” 7/
“Evidence shows that states’ adoption of prenatal substance use policies that focus solely on the criminal justice sector have a chilling effect on admission of pregnant women for treatment of substance use disorder.” 8/
“Third, pregnant and postpartum women should have priority access to insurance coverage expansion programs and other programs that allow for treatment continuation.” 9/
"A compassionate, comprehensive approach to reducing the effects of the opioid epidemic on infants must focus on their mothers and include upstream structural factors and the broader context of their lives…” 10/
“…including community economic conditions and local mental health care infrastructure and capacity.” /end
