Reproductive rights at the U.S. state level and medication access for pregnant women with opioid use.

Despite the rise in chronic, untreated opioid use among pregnant women, their rate of receiving medications for opioid use disorder (MOUD) has remained stagnant since the mid-1990s. Using retrospective cross-sectional substance use treatment admissions data from 2015 to 2019, we examined access to treatment for opioid use by pregnant adults across 48 U.S. states. We found that younger adults, Black women, those referred to treatment by a criminal justice agency (e.g., judge, probation officer), those reporting polysubstance use, and those receiving treatment in residential settings were far less likely to receive MOUD (i.e., methadone, buprenorphine, naltrexone). We used multilevel analysis to examine the structural influence of state-level reproductive rights policies on pregnant women's access to MOUD. Adjusted counterfactual predictions reveal being admitted to treatment in a severely restrictive state context results in a significant decline in the likelihood of receiving MOUD, from 67% to 29%. We estimate 12,609 additional pregnant women seeking treatment for opioid use would have accessed first-line opioid pharmacotherapy if individuals in restrictive states had accessed medication at the same rate as those in more supportive states. Taken together, these findings offer insights into how reproductive rights serve as a structural determinant of health and safeguard for opioid medication treatment. We discuss the consequences of reversing reproductive rights policies amidst rising rates of drug overdose deaths among pregnant women along with the growing availability of illegally manufactured opioid analogs, as well as psychostimulant co-use, re-shaping overdose risk patterns in the U.S.