Opioid Initiation and Conversion to Persistent Use Related to Childbirth among Low-Income Young Philadelphia Mothers
Abstract: Opioid use among women of child-bearing age has increased dramatically in recent years, becoming one of the leading causes of death among young adults in the United States. Long term opioid use often begins with treatment for a painful injury or condition, including childbirth. Identifying vulnerable populations at highest risk for conversion to persistent opioid use following prescription at childbirth is one strategy for targeted intervention at the clinician and patient levels. To this end, young mothers with Medicaid coverage present with a confluence of risk factors. Risk of substance use disorders and entry into early childbearing are disproportionately high among women with histories of exposure to the child welfare system, which includes nearly half of low-income young mothers. Additionally, young mothers not receiving postpartum mental illness treatment continuity are at increased risk of substance use. The objective of this proposal is to examine the role of childbirth in opioid initiation and subsequent persistent use within a population-based sample of Medicaid-insured adolescent and young adult mothers in Philadelphia. We aim to discern the prevalence of postpartum opioid prescription fills and conversion to persistent opioid use; assess the relationship between conversion to persistent opioid use and mothers’ opioid-naïve status, history of child welfare system involvement, and mental health status; and finally, estimate the effect of postpartum psychotropic medication discontinuity on risk of conversion to persistent opioid use among mothers with serious mental illness. The proposed work has implications for care coordination models involving obstetrics, as well as interventions to prevent opioid conversion among high-risk populations.