Prenatal opioid use disorder and child protective service involvement: Does consistent treatment matter?

Background: Infants born to individuals with opioid use disorder (OUD) often face greater scrutiny from child protective services (CPS), particularly in states like Wisconsin that mandate reporting for prenatal substance exposure. While consistent medication for opioid use disorder (MOUD) is recommended to stabilize the prenatal environment, such mandatory reporting policies may discourage seeking treatment.

Methods: This research used Wisconsin's linked administrative data to estimate associations between prenatal OUD diagnosis and CPS involvement, focusing on variation therein by MOUD treatment consistency.

Results: Of the 258,828 Medicaid-covered singleton births from 2010 to 2019, 6091 (2.4 %) were to individuals with OUD. Among these, 2349 (38.6 %) received high consistency treatment (defined as receiving MOUD for 5 or more consecutive months before the birth), 701 (11.5 %) had moderate consistency treatment (2-4 consecutive months), 660 (10.8 %) underwent intermittent treatment (<2 consecutive months), and 2381 (39.1 %) were untreated. Logistic regressions show that OUD diagnosis was associated with elevated risk of CPS referrals and removals within 30 days post-birth. The presence of other co-occurring substance use and mental health disorders was associated with additional increases in these risks. Though individuals receiving MOUD treatment had higher referral risk compared to untreated, those who received moderately and highly consistent treatment faced lower removal risk relative to those with intermittent treatment. Notably, the high consistency treatment group exhibited the lowest referral and removal rates across all treatment groups.

Conclusion: These findings underscore the need to promote high consistency MOUD treatment among pregnant individuals with OUD by clarifying its benefits and mitigating concerns regarding CPS involvement.