78 Americans die daily from an opioid overdose. One of the areas hardest hit by this epidemic is the Appalachian region. To combat this crisis, Congress and the American College of Obstetricians and Gynecologists recommend a multifaceted approach in identifying, monitoring, and managing patients. Medication assisted treatment (MAT) with methadone or buprenorphine is a cornerstone of this therapy. Despite the acceptance of MAT as standard of care, opioid related maternal and neonatal morbidity rates continue to rise.
A survey of all obstetric providers in highly affected counties (as determined by CDC analysis) in West Virginia, Kentucky, Ohio, Tennessee, Indiana, and South Carolina was performed. Providers were asked if they: 1. Prescribe Methadone or buprenorphine. 2. Manage patients who obtain the medications from other prescribers 3. Where did they refer their patients for treatment.
In West Virginia, 47 practices comprising 208 physicians were surveyed. 6.3% of practices (2 Academic, 1 Community) prescribed methadone/buprenorphine. At one academic institution, a sole provider prescribed methadone/buprenorphine. 2.45% of obstetric providers in West Virginia prescribe methadone/buprenorphine. 77% of community practices referred to academic centers for management. 10% were unsure where to refer their patients. Final data is pending for the remaining states and will be displayed numerically and graphically by county.
Our data shows a wide gap both in the quantity and the accessibility of obstetric providers prescribing MAT. The burden of management has fallen disproportionately on academic centers creating a log jam which makes accessing this potentially life-saving treatment in a timely manner out of reach in this high risk population.