The Obstetric Response to the Opioid Epidemic in the Appalachian Region

More than 78 American's die daily from an opioid related overdose; a 500% increase since 2000. The epidemic has effected the Appalachian region of the United States particularly hard. To combat the crisis, ACOG and other leading societies recommend the use of Medication Assisted Treatment (MAT) in the form of methadone or more recently buprenorphine for all pregnant women with opioid addiction. Despite the acceptance of MAT as a standard of care, opioid related maternal and neonatal morbidity rates continue to rise. This study attempts to assess the accessibility of prenatal care and MAT for opioid addicted women in the heart of the crisis. Cross sectional qualitative survey and quantitative geo mapping study using health grades, a publicly available national provider database. Study was conducted among providers in the states of West Virginia, Kentucky, Tennessee, and Virginia. 4.79% of providers surveyed prescribed MAT during pregnancy (N=1,483). Providers in the state of VA had the most prescribers of MAT (N=48) while the state of Kentucky had 0 providers. Only 26.2% of surveyed providers provided prenatal care to opioid addicted women. State and county geo-mapping will further illustrate the data including distribution of providers and their location in comparison to the opioid overdose rates of their respective states. 59.4% of providers surveyed that did not provide prenatal care to opioid addicted women did not have centers where they referred these patients to. Pregnant women in the Appalachian region have fewer options than their non pregnant counterparts for receiving prenatal care and MAT. The distribution of providers in the region present many opioid addicted women with significant challenges in obtaining Prenatal care and MAT. The burden for caring for opioid addicted women has fallen disproportionately on some academic medical centers. More education on the prescribing of MAT and the availability of resources in providers respective communities is needed for obstetric providers particularly in the most affected regions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)