Gaps in Addiction Care Among Hospitalized Reproductive-Aged Women With Opioid Use Diagnoses: A Cross-Sectional Study

OBJECTIVES: This study evaluated the use of addiction consult services and medications for opioid use disorder (MOUD) among hospitalized reproductive-aged women with opioid use diagnoses, examining reach to pregnant women, women admitted to obstetrics, and across race and ethnicity. METHODS: Using electronic health records (2021-2022), we identified admissions among women aged 18-44 with opioid use diagnoses (disorders, poisonings/adverse effects) at 8 New York City public hospitals with addiction consult services. Bayesian hierarchical logistic models estimated associations of being pregnant (vs. not pregnant), admitted to obstetrics (vs. medicine/other departments), and race/ethnicity with consult orders; consult completions; MOUD orders; and MOUD orders among those with completed consults. We report adjusted odds ratios (aOR) and 95% credible intervals (CrIs). RESULTS: Among 547 eligible admissions (388 patients), 11.7% were pregnant and 9.9% were admitted to obstetrics. Patients were Black (23.5%), Hispanic (33.0%), multiracial/other races (13.7%), and White (26.8%). Compared with medicine/other departments, obstetrics patients had lower odds of a consult order (aOR=0.31; 95% CrI: 0.11-0.78). Pregnant patients had lower odds of a consult order compared to nonpregnant patients, though estimates were under uncertainty (aOR=0.53; 95% CrI: 0.21-1.28). Black women had lower odds of a consult order (aOR=0.42; 95% CrI: 0.18-0.96) and MOUD (aOR=0.25; 95% CrI: 0.09-0.71) compared to White women. CONCLUSIONS: Findings highlight pregnancy-related differences and racial inequities in addiction consult service and MOUD utilization during hospitalization, underscoring a potential need for stronger obstetrics-addiction collaboration and equity-focused care.