(95) Perinatal Opioid Use Disorder Program in the Heart of the Opioid Epidemic

Background & Introduction: Philadelphia is currently experiencing an opioid use disorder (OUD) crisis and now has the highest unintentional overdose fatality rate among large cities in the US.1 Additionally, Philadelphia has a greater number of nonfatal overdoses, infectious complications, and other sources of morbidity and mortality among patients struggling with OUD. In Philadelphia, regarded as the epicenter of the opioid epidemic, the predominant driver of peripartum deaths is substance use disorders, playing a role in 58% of all peripartum deaths.1 Disturbingly, in Philadelphia, Non-Hispanic Black women make up 43% of births but account for 73% of Philadelphia’s pregnancy-related deaths.1 Nationally, and in Philadelphia, mental health diagnoses, history of OUD, documented cases with child protective services, intimate partner violence, no prenatal care, and Medicaid insurance are linked with pregnancy associated deaths.2 These determinants have also been connected to decreased care utilization.3,4

These findings demonstrate the need for a robust care model for this marginalized and at-risk population. The Perinatal Resources for Opioid Use Disorder (PROUD) program aims to provide full spectrum support for pregnant and postpartum individuals with OUD, and their infants, with both clinical and wraparound services, to decrease these dire statistics.

Methods: The PROUD program, established in 2021, offers holistic care for birthing individuals and their children (dyad care) with substance use disorders, providing treatment for OUD (and other substances) alongside pregnancy, postpartum, pediatric, and mental health care. The backbone of the clinic is through integrated peer support services. We also facilitate access to primary, HIV, and Viral Hepatitis care.

Through grant implementation in 2023, the program provides transportation assistance, phones, pregnancy and child supplies, wardrobe, and job ready programs. as well as linkage to social services and community organizations to better health outcomes. The clinic’s aim is to simplify the complex American healthcare and social services landscape, becoming a “one-stop shop” for patients.

In 2024 PROUD began a peripartum group session with integrated recovery, pregnancy, postpartum, and neonatal care sessions. Though collaboration with community organizations we have successfully linked patients to peer support, resources, and birthing support.

Our organization evaluates its effectiveness through monthly quantitative reviews tracking new referrals, return patient visits, inpatient hospitalizations, births, and delivery outcomes. Annually, we assess the rates of use of medications for substance disorders, rates of return to use, and the utilization of social services. We also gather direct feedback through focus groups and patient panels. In a mixed-methods approach, we qualitatively and quantitatively analyze the impact pre and post the social support grant on healthcare utilization outcomes.

Results: Since the creation of PROUD in 2021 we have cared for 106 maternal infant dyads, with 67.4% identifying as black, Hispanic, or American Indian. Our support services, including transportation assistance, social work support, and flexible counseling, have led to a 29.9% increase in retention rates (p=.033) and a 42.6% decrease in no-show rates (p=042). Additionally significant reductions in neonatal abstinence syndrome rates (p=.046) and emergency room visits (p=.021) have been observed. No differences in delivery outcomes were seen. Qualitative feedback from patients highlights PROUD's holistic, stigma-free care that addresses family needs and fosters peer and community engagement. Voiced recommendations for the future including integrated prenatal planning with the Department of Health, Child Protective Services and more anticipatory guidance on what to expect with these state agencies.

Conclusion & Discussion: These outcomes, along with patient voiced feedback, highlight the necessity of directly addressing basic needs—the social determinants of health—rather than simply noting them in patient histories, to combat high maternal morbidity and mortality rates related to OUD by bettering related health outcomes. Our patients emphasize that fulfilling these needs is essential for them to embark on the challenging journey of recovery. By focusing on these areas, we strive to provide comprehensive support that fosters effective, sustainable, recovery. We demonstrate that this is a reproducible model that can be replicated in similar communities across the US to address rising rates of OUD in pregnant and postpartum populations in diverse inner-city communities.

References: 1. Philadelphia Department of Public Health, 2021

2. Forray, A., & Yonkers, K. A. (2021). The collision of mental health, substance use disorder, and suicide. Obstetrics & Gynecology, 137(6), 1083-1090.

3. Trost, S. L., Beauregard, J. L., Smoots, A. N., Ko, J. Y., Haight, S. C., Moore Simas, T. A., ... & Goodman, D. (2021). Preventing Pregnancy-Related Mental Health Deaths: Insights From 14 US Maternal Mortality Review Committees, 2008–17: Study examines maternal mortality and mental health. Health Affairs, 40(10), 1551-1559.

4. Bellerose, M., Collin, L., & Daw, J. R. (2022). The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review: Systematic review examines the effects of expanding Medicaid on insurance coverage, health care use, and health outcomes during preconception, pregnancy, and postpartum. Health Affairs, 41(1), 60-68.