State Policy Levers for Expanding Family-Centered Medication-Assisted Treatment
Growing rates of opioid misuse and opioid use disorder (OUD) in the United States are often described in terms of overdose deaths, opioid prescriptions, and number of individuals with OUD. While these are valuable metrics that help quantify the problem, they obscure the fact that opioid abuse occurs not within a vacuum, but within families and social networks and these families and networks face consequences of addiction alongside the individual.
Pregnancy is a particularly critical time to address OUD, as prenatal maternal opioid use is associated with serious complications for the baby including premature birth and neonatal abstinence syndrome (NAS). Women may also be more receptive to seeking treatment during this transitional period of their lives.
Given the interplay of addiction, family, and pregnancy, states and programs are increasingly acknowledging the value of providing treatment to pregnant and parenting women through family-centered programs. These programs recognize women’s roles as caregivers within the family unit, include their children, partners, and/or other family members in the treatment process, and provide clinical care for all affected family members. In addition to clinical treatment - which includes use of medication-assisted treatment (MAT) as a best practice for treating pregnant and parenting women -- family-centered programs include a range of supportive and community-based services. Family-centered programs incorporating MAT can improve pregnancy outcomes by shielding mothers from the drug use environment and engaging them in a network of support. However, many challenges remain for expanding pregnant and parenting women’s access to family-centered programs that incorporate MAT. Issues such as stigma, unstable or unaffordable housing, lack of specialty providers, and lack of funding have been cited as barriers to treatment for women. Provider unwillingness to provide MAT to pregnant women - either due to lack of credentialing or training in this area, bias, or a combination of these factors - is also a common barrier.
Nevertheless, a number of states are incorporating family-centered treatment principles into MAT services and supporting innovative approaches to creating relevant clinical and community linkages. This paper explores the core components of a family-centered MAT program framework; provides an overview of state variation in eligibility requirements and care coordination; summarizes four states’ individual approaches to treatment; and discusses challenges, barriers, and recommendations for future work in this critical area.