Converging Health Crises: The Impact of COVID-19 and the Opioid Epidemic on Pregnant Women

By Sophia Kenward, SWHR Communications and Policy Intern  

The national opioid epidemic was already raging before COVID-19 hit the United States. During the pandemic, the situation severely worsened, including for those who are pregnant.   

The pandemic brought a massive increase in opioid overdose deaths. The United States experienced its highest number of overdose deaths ever recorded — 81,230 — for the 12-month period ending in May 2020. Commonwealth Fund estimates show that overdose deaths spiked to record levels when the pandemic hit in March 2020 and that monthly deaths grew by about 50% — to more than 9,000 — from February to May 2020.  

Coinciding with the growing opioid epidemic over the past decade, the rate of substance use among pregnant women has also risen significantly. This correlation is likely to hold true during the pandemic as stressors from both pregnancy and the pandemic can influence substance use.. For instance, the pandemic has impacted the mental health of many pregnant people. In one study, pregnant individuals were more likely to report feeling anxious, depressed, lonely, and report having suicidal thoughts during the pandemic.  

An analysis of health care claims by FAIR Health revealed that diagnoses of neonatal abstinence syndrome (NAS), a group of conditions that occur when babies are exposed to opioids in the womb, jumped 18% from April to May 2020. The report also noted that from May to July 2020, NAS diagnoses remained above the levels seen in the same months the previous year. Newborns with NAS may have withdrawal symptoms, low birthweight, jaundice, or seizures, and may require treatment in the neonatal intensive care unit. While long-term research on NAS is still needed, it is believed that NAS may lead to long-term complications and developmental delays for the baby, such as problems with hearing or vision issues and learning or behavior. 

Barriers to Treatment

Pregnant and postpartum women who suffer from opioid use disorder (OUD) also face unique challenges and barriers to treatment that were exacerbated by the pandemic. Especially early in the pandemic, many individuals experienced traumatic births where they were separated from their partners or their newborns due to COVID-19 safety protocols. New moms were also pushed into isolation and unable to rely on assistance from their support systems due to stay-at-home orders.

The pandemic caused job loss, social isolation, and financial insecurity, all of which may trigger someone recovering from addiction to return to substance use, or result in someone turning to substance use to cope with stress. In addition, stigma and fear of criminal justice consequences are powerful forces in preventing pregnant women and new moms from engaging in treatment. Mothers with OUD face threats of arrest, incarceration, and loss of custody of their child, leading some to isolate themselves, skip treatment appointments, or avoid treatment altogether.   

Treatments like buprenorphine and methadone can be used to successfully treat OUD in pregnant individuals, but the pandemic limited access to buprenorphine, according to a study by researchers at Princeton University. People with access to this treatment before the pandemic continued to receive prescriptions at comparable rates, but the number of buprenorphine prescriptions for new patients decreased by almost a quarter at the start of the pandemic. An estimated 37,000 fewer people received buprenorphine treatment as a result of the COVID-19 pandemic. This could worsen treatment disparities for Black and Hispanic pregnant women and pregnant individuals who live in rural communities.  

Black and Hispanic pregnant women are already less likely than white pregnant women to receive medication for OUD and less likely to use it consistently. Many factors can influence consistent use of medication, and the study authors noted that “punitive policy responses toward pregnant women who use drugs … may make women of color distrustful about disclosing substance use during pregnancy and result in avoidance of treatment.” They also cite barriers such as racial discrimination by clinicians, cultural barriers, perceived stigma, and minimal social supports.  

Pregnant individuals in rural communities also face challenges in accessing buprenorphine and methadone due to the lack of substance use treatment infrastructure and small number of physicians providing treatment — plus, those that do prescribe these medications frequently may not have a comfort level in treating pregnant patients. However, since 2016, the number of clinicians eligible to prescribe buprenorphine per 100,000 people in rural areas has increased by 111%, a promising development for improving access to treatment.

Potential Solutions

According to clinicians in rural Colorado, the expansion of telehealth during the pandemic has been a “game changer” for treating OUD in rural communities, allowing providers to access patients who need treatment but were formerly unable to meet in-person. However, clinics for pregnant women with OUD have reported mixed results with telemedicine.  

One clinic reported that telemedicine allowed for more check-ins with its pregnant patients with OUD and that it had fewer no-shows to prenatal appointments. Meanwhile, another practice reported that the transition to telehealth led to a decline in attendance of virtual group therapy sessions among pregnant women with OUD, decreasing threefold compared to in-person group therapy sessions. Common reasons these women did not attend virtual group therapy were lack of access to or malfunctioning technology, unreliable internet, or inability to meet in a location appropriate for patient privacy. In order for rural communities to effectively make use of telehealth in the long term, the disparities that prevent telehealth access must be addressed — for example, expanding broadband internet services into more rural areas.  

Finally, support for women with OUD is critical during the postpartum period, with one study reporting that overdose rates were highest 7-12 months after delivery. However, pregnancy-related coverage through Medicaid ends in many states after 60 days delivery, leaving mothers with OUD more vulnerable to overdose. Expanding Medicaid coverage so that mothers can stay enrolled through one year postpartum could help reduce health disparities for postpartum people with OUD and provide broader access to treatments that improve maternal health outcomes.   

Next Steps

Health emergencies like the opioid crisis have taken a backseat as public health officials focused their efforts and funds on confronting the global COVID-19 pandemic. Now that vaccines are available and the pandemic is under better control, it is important to address the health of pregnant and postpartum individuals with OUD.  

 The extent to which the pandemic has affected the opioid crisis and pregnant individuals with OUD is not fully clear yet, so funding research into the effects of the pandemic on substance use in pregnancy and postpartum is critical. In addition, expanding the Medicaid coverage for postpartum individuals, addressing the stigma around OUD in pregnancy, and providing better support for pregnant people who experience mental health and substance use challenges are important steps to providing better care for pregnant and postpartum individuals with OUD.