Rural-Urban Differences in Medication Treatment for Opioid Use Disorder Among Pregnant Women

This project will address the following questions:

1. How does the need for Opioid Use Disorder (OUD) treatment (i.e., OUD per 10,000 pregnant women) differ among pregnant women living in rural and urban areas in the United States?
2. How does Medication for Opioid Use Disorder (MOUD) initiation and continuity differ by residence rurality among pregnant Medicaid beneficiaries?
3. Where do pregnant Medicaid enrollees with OUD receive prenatal care and/or MOUD and how these settings differ between rural and urban beneficiaries with OUD? What proportion of rural and urban enrollees received prenatal care and/or MOUD in outpatient/office-based settings (including OB/GYN and maternal fetal medicine/high-risk pregnancy clinics), inpatient facilities, emergency departments, Opioid Treatment Programs (OTPs), FQHCs, telehealth-enabled outpatient care, or other settings? For the MOUD records, we will further distinguish services by American Society of Addiction Medicine (ASAM) level of care: outpatient (Level 1), intensive outpatient/partial hospitalization (Level 2), residential (Level 3), and inpatient/medically managed intensive care (Level 4).
4. How has telehealth use for MOUD initiation and follow-up differed between rural and urban pregnant Medicaid beneficiaries?

At the end of the study, the findings will identify where geographic differences in OUD treatment occur and which components of the treatment system may warrant targeted investments in workforce capacity, care delivery infrastructure, telehealth, and reimbursement and supportive services.