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The United States continues to experience high rates of maternal mortality—the highest rates among high-income nations—with large variations by state, race, and ethnicity. This public health challenge is multifactorial, yet one driver that is often left out of the conversation is addiction. But opioid use disorder is a significant concern and contributing factor. A 2023 analysis of perinatal mortality from 2018-2021 found that overdose deaths more than tripled among pregnant and postpartum women between the ages of 35 and 44, and increased in all other age groups, as well.
Unfortunately, it can be extremely challenging for people who are pregnant and living with opioid use disorder to find addiction treatment. Many healthcare providers are unwilling to treat opioid use disorder, let alone in individuals who are pregnant, and even when a provider is willing to prescribe medications for opioid use disorder, stigma can be a major blocker. Furthermore, the stigma and expectation of judgment can keep some individuals from seeking substance use treatment and prenatal care in the first place. For some pregnant people with opioid use disorder, that stigma goes hand in hand with a fear that if their substance use is discovered, they will lose custody after giving birth. In addition to these concerns, perinatal patients with opioid use disorder face the same barriers to access that hinder wider populations—lack of providers, onerous and time-consuming program requirements, and the monetary cost of treatment. These barriers may contribute to the fact that the 2023 analysis mentioned above found that most overdose deaths among pregnant and postpartum individuals took place outside of healthcare settings. The medical community needs to make perinatal medication for opioid use disorder less stigmatizing and more accessible.
Workit Health offers evidence-based care for opioid and alcohol use disorders using a medication-first, telehealth approach. Founded by two women in recovery, Workit Health takes a patients-as-designers perspective that prioritizes harm reduction and empowers members to have agency in their own recovery. Via the custom Workit Health app, members attend video visits with a medical provider, engage in behavioral health support in group settings, and complete urine drug screens, all online. Workit Health members are able to receive safe and effective opioid use disorder care from the comfort and privacy of their own homes. This innovative approach to delivering care reduces stigma, increases access to care, and makes medication for opioid use disorder more affordable.
Buprenorphine, one of the primary medications used to treat opioid use disorder, is effective and safe during pregnancy. Medication for opioid use disorder is not only associated with reducing the risk of overdose, but also with lower rates of preterm and very preterm birth. The American College of Obstetricians and Gynecologists recommends medication for opioid use disorder during pregnancy over medically supervised withdrawal, which is associated with high relapse rates, leading to worse outcomes.
It has been suggested that the privacy and flexibility of telehealth might decrease stigma and increase access to medication for opioid use disorder care for this population. To gain insight into this area, Workit Labs, the research and development arm of Workit Health, analyzed outcomes of pregnant members who received telehealth treatment for opioid use disorder. The study was funded by a Small Business Innovation Research contract from the National Institute on Drug Abuse.
The analysis found that about 80% of participants received continuous medication for opioid use disorder throughout pregnancy—with 8% of them transferring to prenatal providers and 92% continuing to receive treatment via telehealth. Among the 92% who stayed in telehealth treatment, the vast majority (94%) remained in treatment through six weeks post-pregnancy, and all of them tested positive for buprenorphine in post-pregnancy urine drug screens. This is important because gaps in treatment and buprenorphine coverage can increase the risk for overdose. These outcomes provide excellent support for the use of telehealth treatment for opioid use disorder for pregnant people who struggle with opioids. Before this study from Workit Labs, the only comparable study was based within an obstetric practice rather than one for addiction treatment. Despite the difference in practice specialty, the findings were nearly identical.
This study provides a hopeful avenue for treating maternal opioid use disorder moving forward. The telehealth model makes care easier to access without long travel distances and time in waiting rooms, the harm reduction approach makes it less stigmatizing, and the at-home component makes members feel safer and more private. As the opioid epidemic continues to impact the nation as a whole and the pregnant population in specific, the potential impact of telehealth treatment programs for opioid use disorder is encouraging.
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