Wang, Y., Ehrenthal, D., Bo, A., & Berger, L. (2025). Prenatal opioid use disorder and child protective service involvement: Does consistent treatment matter? Journal of Substance Use and Addiction Treatment, v 172.
Summary
Canada is the second-largest consumer of prescription opioids in the world, after the USA. Prenatal opiod use disorder (OUD) is a major risk factor for child protection service (CPS) involvement. OUD has been a particularly devastating crisis in some First Nations communities and lack of access to effective OUD services is one of the drivers for the unacceptably high rates of removal of First Nations children. Because detoxification during pregnancy risks harming the mother and the fetus, medications for opioid use disorder (MOUD) is the recommended treatment for pregnant women with an OUD. By linking Medicaid data with CPS records in Wisconsin, this study examined the relationship between adherence to MOUD treatment and CPS removal.
As expected, the study found that OUD diagnosis was associated with elevated risk of CPS referrals and removals. Although mothers receiving MOUD treatment had higher referral risk compared to untreated mothers, those who received consistent treatment faced lower risk of removal.
These findings underscore the importance of clear messaging and coordination between substance abuse treatment services and CPS. The fear of being reported to CPS may keep some mothers with OUD away from treatment services, yet this study found that the risk of removal decreases for mothers who receive consistent treatment.
Methodological Notes
This study used Wisconsin’s linked administrative data to follow 258,828 Medicaid-covered singleton births from 2010 to 2019, 6091 2.4 % of whom were to mothers with OUD. More than half (61%) of theses women received MOUD treatment, ranging from consistent treatment for 5 or more consecutive months, to moderate consistency treatment (2–4 consecutive months treatment), to intermittent treatment for under 2 consecutive months. Logistic regressions analyses were used to compare CPS referral and removal rates for all four groups while controlling for (1) socio-demographic factors, (2) co-occurrence of mental health and other substance abuse disorders and (3) neonatal opioid withdrawal syndrome (NOWS) which is more likely to occur with MOUD treatment.
Some caution is warranted in extending these findings to Canada given the differences in health care coverage. It should also be noted that while the use of logistic regression analyses controls for some confounders, there may nevertheless be other differences that could be associated with treatment. Finally, the use of Medicaid claims to document OUD diagnosis did not include undiagnosed illicit opioid use which could further confound the findings.