Original Article

Provision of Buprenorphine to Pregnant Women by For-Profit Clinics in an Appalachian City

Authors: Jessica J. Walker, MD, Martin E. Olsen, MD

Abstract

Objectives: This study was undertaken to confirm that patient reports on buprenorphine medication-assisted therapy in for-profit buprenorphine clinics in our community were personally costly. We contacted all 17 for-profit clinics in our community and confirmed the patient reports that a significant financial payment of ≤$100 was required for each visit. We also found that tapering of buprenorphine dosage in pregnancy was offered by several of the clinics.

Methods: A telephone survey was conducted with the 17 for-profit buprenorphine clinics located in the Johnson City, Tennessee area. The clinic representative who answered the telephone was asked questions regarding patient costs for therapy and availability of tapering programs for pregnant women.

Results: Patient reports that the for-profit clinics are costly were confirmed. None of the clinics accepted insurance reimbursement of any type. The most common weekly costs were $100 per visit. A majority of clinics offered biweekly or monthly visits at significantly increased rates. Clinic representatives stated that a majority of clinics would consider buprenorphine tapering programs for pregnant women.

Conclusions: The high cost of for-profit clinics is a barrier for patient access to medication-assisted therapy with buprenorphine. Tapering of buprenorphine dosage in pregnant women has penetrated buprenorphine management practice in our community. Further research is needed to determine whether elimination of cost barrier would have a positive effect on the rates of neonatal abstinence syndrome.

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References

1. Patrick SW, Schumacher RE, Benneyworth BD, et al. Neonatal abstinence syndrome and associated health care expenditures: United States, 2000-2009. JAMA 2012;307:1934-1940.
 
2. Warren MD, Miller AM, Traylor J, et al. Implementation of a statewide surveillance system for neonatal abstinence syndrome-Tennessee, 2013. MMWR Morb Mortal Wkly Rep 2015;64:125-128.
 
3. Erwin PC, Meschke LL, Ehrlich SF, et al. Neonatal abstinence syndrome in east Tennessee: characteristics and risk factors among mothers and infants in one area of Appalachia. J Health Care Poor Underserved 2017;28:1393-1408.
 
4. Wiegand SL, Stringer EM, Stuebe AM, et al. Buprenorphine and naloxone compared with methadone treatment in pregnancy. Obstet Gynecol 2015;125:363-368.
 
5. Bell J, Towers CV, Hennessy MD, et al. Detoxification from opiate drugs during pregnancy. Am J Obstet Gynecol 2016;215:374.e1-374.e6.
 
6. Rizzo RA, Neumann AM, King SO, et al. Parenting and concerns of pregnant women in buprenorphine treatment. MCN Am J Matern Child Nurs 2014;39:319-324.
 
7. ACOG Committee on Health Care for Underserved Women American Society of Addiction Medicine. ACOG Committee Opinion No. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012;119:1070-1076.
 
8. Committee on Obstetric Practice. Committee Opinion No. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017;130:e81-e94.
 
9. Stewart RD, Nelson DB, Adhikari EH, et al. The obstetrical and neonatal impact of maternal opioid detoxification in pregnancy. Am J Obstet Gynecol 2013;209:267.e1-267.e5.
 
10. Dashe JS, Jackson GL, Olscher DA, et al. Opioid detoxification in pregnancy. Obstet Gynecol 1998;92:854-858.
 
11. Luty J, Nikolaou V, Bearn J. Is opiate detoxification unsafe in pregnancy? J Subst Abuse Treat 2003;24:363-367.
 
12. Kermack A, Flannery M, Tofighi B, et al. Buprenorphine prescribing practice trends and attitudes among New York providers. J Subst Abuse Treat 2017;74:1-6.
 
13. Meyer M, Phillips J. Caring for pregnant opioid abusers in Vermont: a potential model for non-urban areas. Prev Med 2015;80:18-22.
 
14. Molfenter T, Sherbeck C, Zehner M, et al. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. Subst Abuse Treat Prev Policy 2015;10:13.
 
15. Allen B, Harocopos A. Non-prescribed buprenorphine in New York City: motivations for use, practices of diversion, and experiences of stigma. J Subst Abuse Treat 2016;70:81-86.