Contraception claims by medication for opioid use disorder prescription status among insured women with opioid use disorder, United States, 2018



      To understand how contraception method use differed between women prescribed and not prescribed medications for opioid use disorder (MOUD) among commercially-insured and Medicaid-insured women.

      Study Design

      IBM Watson Health MarketScan Commercial Claims and Encounters database and the Multi-State Medicaid database were used to calculate the (1) crude prevalence, and (2) adjusted odds ratios (adjusted for demographic characteristics) of using long-acting reversible or short-acting hormonal contraception methods or female sterilization compared with none of these methods (no method) in 2018 by MOUD status among women with OUD, aged 20 to 49 years, with continuous health insurance coverage through commercial insurance or Medicaid for ≥6 years. Claims data was used to define contraception use. Fisher exact test or χ2 test with a P-value ≤ 0.0001, based on the Holm-Bonferroni method, and 95% confidence intervals were used to determine statistically significant differences for prevalence estimates and adjusted odds ratios, respectively.


      Only 41% of commercially-insured and Medicaid-insured women with OUD were prescribed MOUD. Medicaid-insured women with OUD prescribed MOUD had a significantly lower crude prevalence of using no method (71.1% vs 79.0%) and higher odds of using female sterilization (aOR, 1.33; 95% CI: 1.06–1.67 vs no method) than those not prescribed MOUD. Among commercially-insured women there were no differences in contraceptive use by MOUD status and 66% used no method.


      Among women with ≥ 6 years of continuous insurance coverage, contraceptive use differed by MOUD status and insurance. Prescribing MOUD for women with OUD can be improved to ensure quality care.


      Only two in five women with OUD had evidence of being prescribed MOUD, and majority did not use prescription contraception or female sterilization. Our findings support opportunities to improve prescribing for MOUD and integrate contraception and MOUD services to improve clinical care among women with OUD.


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        • Handy CJ
        • Lange HLH
        • Manos BE
        • Berlan ED
        • Bonny AE.
        A retrospective chart review of contraceptive use among adolescents with opioid use disorder.
        J Pediatr Adolesc Gynecol. 2018; 31 (doi:): 122-127
        • Robinowitz N
        • Muqueeth S
        • Scheibler J
        • Salisbury-Afshar E
        • Terplan M.
        Family planning in substance use disorder treatment centers: opportunities and challenges.
        Subst Use Misuse. 2016; 51 (doi:): 1477-1483
        • Cornford CS
        • Close HJ
        • Bray R
        • Beere D
        • Mason JM.
        Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study.
        PLoS One. 2015; 10 (doi:)e0116231
        • Terplan M
        • Hand DJ
        • Hutchinson M
        • Salisbury-Afshar E
        • Heil SH.
        Contraceptive use and method choice among women with opioid and other substance use disorders: A systematic review.
        Prev Med. Nov. 2015; 80 (doi:): 23-31
        • Heil SH
        • Melbostad HS
        • Rey CN.
        Innovative approaches to reduce unintended pregnancy and improve access to contraception among women who use opioids.
        Prev Med. Nov. 2019; 128 (doi:)105794
        • Finer LB
        • Zolna MR.
        Declines in unintended pregnancy in the United States, 2008-2011.
        N Engl J Med. 2016; 374 (Mar 3doi:): 843-852
        • Hirai AH
        • Ko JY
        • Owens PL
        • Stocks C
        • Patrick SW.
        Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010-2017.
        JAMA. 2021; 325 (doi:): 146-155
      1. American college of obstetricians and gynecologists. committee opinion no. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol. Aug 2017;130(2):e81-e94. doi: 10.1097/aog.0000000000002235

        • Klaman SL
        • Isaacs K
        • Leopold A
        • Perpich J
        • Hayashi S
        • Vender J
        • et al.
        Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: literature review to support national guidance.
        J Addict Med. 2017; 11 (May/Jundoi:): 178-190
        • Ko JY
        • Wolicki S
        • Barfield WD
        • Patrick SW
        • Broussard CS
        • Yonkers KA
        • et al.
        CDC grand rounds: public health strategies to prevent neonatal abstinence syndrome.
        MMWR Morb Mortal Wkly Rep. 2017; 66 (Published 2017 Mar 10doi:): 242-245
        • Patrick SW
        • Barfield WD
        • Poindexter BB
        Committee on fetus and newborn, committee on substance use and prevention. Neonatal opioid withdrawal syndrome.
        Pediatrics. 2020; 146 (doi:)e2020029074
      2. Substance Abuse and Mental Health Services Administration. Medications for opioid use disorder TIP 63 treatment improvement protocol for healthcare and addiction professionals, policymakers, patients, and families. Substance Abuse and Mental Health Services Administration. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Available at:; 2021 [accessed 24 January 2022].

        • Hansen L.
        White Paper: IBM MarketScan Research Databases for life sciences researchers.
        IBM Watson Health, 2018 (Available at)
        • Brittain AW
        • Tevendale HD
        • Mueller T
        • et al.
        The teen access and quality initiative: improving adolescent reproductive health best practices in publicly funded health centers.
        J Community Health. 2020; 45 (doi:): 615-625
      3. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association; 2013.

      4. U.S. Federal Food and Drug Administration. Information about Medication-Assisted Treatment (MAT). Available at:; Last updated February 14, 2019 [accessed 30 July 2021]

      5. Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc.; 2018.

        • Curtis KM
        • Tepper NK
        • Jatlaoui TC
        • Berry-Bibee E
        • Horton LG
        • Zapata LB
        • et al.
        US Medical Eligibility Criteria for Contraceptive Use.
        MMWR Recomm Rep. 2016; 65 (2016Doi): 1-103
        • Holm S.
        A Simple Sequentially Rejective Multiple Test Procedure.
        Scandinavian J Statistics. 1979; 6 (Available at): 65-70
        • Dehlendorf C
        • Krajewski C
        • Borrero S.
        Contraceptive counseling: best practices to ensure quality communication and enable effective contraceptive use.
        Clin Obstet Gynecol. 2014; 57 (Doi): 659-673
        • Higgins JA
        • Kramer RD
        • Ryder KM.
        Provider bias in long-acting reversible contraception (LARC) promotion and removal: perceptions of young adult women.
        Am J Public Health. 2016; 106 (Doi): 1932-1937
      6. Madras BK, Ahmad NJ, Wen J, Sharfstein JS. Improving access to evidence-based medical treatment for opioid use disorder: strategies to address key barriers within the treatment system. NAM Perspect. 2020 Apr 27;2020:10.31478/202004b. doi: 10.31478/202004b. PMID: 35291732

        • Lagisetty PA
        • Ross R
        • Bohnert A
        • Clay M
        • Maust DT.
        Buprenorphine treatment divide by race/ethnicity and payment.
        JAMA Psychiatry. 2019; 76 (Doi): 979-981
        • Stahler GJ
        • Mennis J.
        Treatment outcome disparities for opioid users: Are there racial and ethnic differences in treatment completion across large US metropolitan areas?.
        Drug Alcohol Depend. 2018; 190 (Doi): 170-178
      7. United States Government Accountability Office. Opioid Addiction: Laws, regulations and other factors can affect medication-assisted treatment access. Available at: September 2016. [Accessed 16 June 2022].

        • Stone RH
        • Griffin B
        • Fusco RA
        • Vest K
        • Tran T
        • Gross S.
        Factors affecting contraception access and use in patients with opioid use disorder.
        J Clin Pharmacol. 2020; 60 (SupplDoi): S63-S73
        • Wolgemuth TE
        • Cuddeback M
        • Callegari LS
        • Rodriguez KL
        • Zhao X
        • Borrero S.
        Perceived barriers and facilitators to contraceptive use among women veterans accessing the veterans affairs healthcare system.
        Womens Health Issues. 2020; 30 (Doi): 57-63
        • Black KI
        • Day CA.
        Improving access to long-acting contraceptive methods and reducing unplanned pregnancy among women with substance use disorders.
        Subst Abuse. 2016; 10 (SupplDoi): 27-33
        • Phillippi JC
        • Schulte R
        • Bonnet K
        • Schlundt DD
        • Cooper WO
        • Martin PR
        • et al.
        Reproductive-age women’s experience of accessing treatment for opioid use disorder: “We Don’t Do That Here”.
        Womens Health Issues. 2021; 31 (Doi): 455-461
        • Mackey K
        • Veazie S
        • Anderson J
        • Bourne D
        • Peterson K.
        Barriers and facilitators to the use of medications for opioid use disorder: a rapid review.
        J Gen Intern Med. 2020; 35 (SupplDoi): 954-963
      8. Orgera K, Tolbert J. Key facts about uninsured adults with opioid use disorder. Henry J Kaiser Family Foundation, Available at:; 2019.

      9. Revisiting Churn: An Early Understanding of State-Level Health Coverage Transitions Under the ACA.
        National Academy for State Health Policy, 2016 (Available at)
        • Conway D.
        Health Insurance Coverage Among Young Adults Aged 19 to 34: 2018 and 2019.
        U.S. Department of Commerce, U.S. Census Bureau, 2020 (Available at)
        • Pazol K
        • Kramer MR
        • Hogue CJ.
        Condoms for dual protection: patterns of use with highly effective contraceptive methods.
        Public Health Rep. 2010; 125 (Doi): 208-217
        • Centers for Disease Control and Prevention
        Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: Summary guidance from CDC and the U.S. Department of Health and Human Services.
        MMWR Recomm Rep. 2012; 61: 1-46