Opioid Use Disorder Documented at Delivery Hospitalization - United States, 1999-2014

Abstract

Opioid use by pregnant women represents a significant public health concern given the association of opioid exposure and adverse maternal and neonatal outcomes, including preterm labor, stillbirth, neonatal abstinence syndrome, and maternal mortality (1,2). State-level actions are critical to curbing the opioid epidemic through programs and policies to reduce use of prescription opioids and illegal opioids including heroin and illicitly manufactured fentanyl, both of which contribute to the epidemic (3). Hospital discharge data from the 1999-2014 Healthcare Cost and Utilization Project (HCUP) were analyzed to describe U.S. national and state-specific trends in opioid use disorder documented at delivery hospitalization. Nationally, the prevalence of opioid use disorder more than quadrupled during 1999-2014 (from 1.5 per 1,000 delivery hospitalizations to 6.5; p<0.05). Increasing trends over time were observed in all 28 states with available data (p<0.05). In 2014, prevalence ranged from 0.7 in the District of Columbia (DC) to 48.6 in Vermont. Continued national, state, and provider efforts to prevent, monitor, and treat opioid use disorder among reproductive-aged and pregnant women are needed. Efforts might include improved access to data in Prescription Drug Monitoring Programs, increased substance abuse screening, use of medication-assisted therapy, and substance abuse treatment referrals.

FIGURE 1

National prevalence of opioid use disorder per 1,000 delivery hospitalizations — National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), United States, 1999–2014 * Prevalence numerator consisted of cases of opioid type dependence and nondependent opioid abuse based on International Classification of Diseases, Ninth Revision (ICD-9) codes (304.00–304.03, 304.70–304.73, 305.50–305.53), and denominator consisted of delivery hospitalization discharges. ^† Includes data from all states participating in HCUP each year (https://www.hcup-us.ahrq.gov/partners.jsp?NIS), weighted to produce national estimates. Rates before 2012 are weighted with trend weights, and rates after 2012 are weighted using original NIS discharge weights to account for the change in NIS design in 2012.

FIGURE 2

Prevalence of opioid use disorder per 1,000 delivery hospitalizations — State Inpatient Database, Healthcare Cost and Utilization Project, 28 states, 2013–2014 * Prevalence numerator consisted of opioid type dependence and nondependent opioid abuse based on International Classification of Diseases, Ninth Revision (ICD-9) codes (304.00–304.03, 304.70–304.73, 305.50–305.53), and denominator consisted of state delivery hospitalization discharges. ^† Prevalence reported are for 2014, except for two states (Massachusetts and South Carolina) for which 2014 data were not available; 2013 data are reported for these states.