Year: 2021
Type: letter
Abstract: We thank our colleagues Reddy and Schiff for their thoughtful letter [1] in response to our recent article [2]. They note that neonatal abstinence syndrome (NAS) is a heterogeneous outcome and that dyadic outcomes are preferred. Further, they note that administrative data may not represent how implementation of policies aimed to address substance use in pregnancy affect “real-world clinical practice.” We agree that in both research and clinical practice, focusing on the maternal–infant dyad is preferable to focusing on either in isolation. In recent work, we have linked mothers and infants in Medicaid MAX data to examine postpartum treatment receipt among women whose infants were identified as being exposed to substances in utero or diagnosed with NAS [3]. Unfortunately, there are relatively few data sets containing linked data and those that exist often reflect limited populations [4]. Given the urgency of the opioid crisis, we believe using non-linked data is still critical for improving outcomes for this vulnerable population. In our study, we used NAS as a proxy for opioid use among reproductive age women at the population level. Although, as Reddy and Schiff note, it is an imperfect measure, it is coded with a great degree of reliability in the setting of clinically significant withdrawal [5]. Reddy and Schiff's observation about inconsistencies in how policy data sets define and classify policies is a critically important issue and a broader challenge for opioid policy research beyond substance use in pregnancy [6]. Documentation regarding how specific policies are defined is often lacking, and analyses using data sources with different definitions can show different effects for the same policy [7]. As experts have noted, moving toward greater transparency in the documentation of policy data sets, including those related to substance use in pregnancy, should help to address this issue [8]. An example includes the National Institute on Drug Abuse (NIDA)-funded Opioid Policy Tools and Information Center (OPTIC) repository of vetted policy data sets, which provides a number of commonly used opioid policy data sets for use by the research community [9], including documentation of similarities and differences in similar data sets from different sources. We are also optimistic that other research groups around the United States are diving deeper into individual policies and updating the legal scan that created the policy database used in our study, enhancing the quality of policy variables used to examine the effects of substance use in pregnancy. With the rapid pace at which potentially harmful policies are being considered and enacted, we believe these policies warrant careful study with appropriate caveats and limitations. Last, we agree that qualitative studies that include a variety of stakeholder perspectives on how these policies operate in real-world clinical practice are fundamentally important to answering questions that cannot be addressed by empirical studies such as ours. We need to understand how policies are viewed by those who enact them, implement them, and are directly affected by them. We are optimistic that with linked data sets permitting analysis of other key outcomes and rigorous policy content analyses, researchers can continue pursuing the most pressing questions about how policies may have unintended harms for dyads affected by perinatal substance use. We thank the authors for their comments and their leadership in this field. None. Faherty, Patrick, and Stein conceptualized, drafted, and revised this manuscript; All authors approve the final version as submitted.
Source: Addiction
DOI: 10.1111/add.15669
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3195594798