PREVALENCE OF MARIJUANA AND OPIOID USE DURING PREGNANCY IN THE UNITED STATES FROM 2017-2019

Christina Renee Brumley

doi:10.7273/000007028

Background: Marijuana use during pregnancy is increasing and is associated with several deleterious outcomes. Thirty-seven states have legalized marijuana for recreational or medical use. Simultaneously, the U.S. is experiencing an opioid epidemic, which is mirrored in pregnant women. Perinatal women have highlighted the use of marijuana in lieu of opioids and other analgesics. Objective: To examine the frequency of marijuana use, opioid use, and co-use during pregnancy and to explore the effect of marijuana policies on trends in perinatal substance use. Methods: Using the Pregnancy Risk Assessment Monitoring System (PRAMS) database, we examined the prevalence of marijuana use, opioid use, and co-use during pregnancy in n=37,206 records across 13 states from 2017-2019. Chi Squared tests, bivariate logistic regressions, and difference-in-difference analyses were performed to compare perinatal substance use between states with differing marijuana policies. To reflect the modification of marijuana policies in several states, analyses were performed for 2017-2018 and 2019 separately. Results: The overall prevalence of self-reported marijuana use during pregnancy was 7.3%, self-reported opioid use was 5.6%, and self-reported co-use was 1.0%. Women in states with recreational marijuana laws had higher odds of self-reported prenatal marijuana use (2017-2018 OR: 2.621, 95% CI: 2.113-3.252; 2019 OR: 1.590, 95% CI: 1.402-1.802) and lower odds of opioid use (2019 OR: 0.490, 95% CI: 0.426-0.563) than those in illegal states. Women in recreational states also had higher odds of prenatal marijuana use (2017-2018 OR: 1.826, 95% CI: 1.459-2.285; 2019 OR: 1.458, 95% CI: 1.265-1.682) and lower odds of opioid use (2019 OR: 0.617, 95% CI: 0.542-0.726) compared to those in medically legal states. Women in medically legal states had higher odds of marijuana use (2017-2018 OR: 1.214, 95% CI: 1.091-1.351; 2019 OR: 1.220, 95% CI: 1.066-1.398) and lower odds of opioid use (2017-2018 OR: 0.597, 95% CI: 2.0.532-0.669; 2019 OR: 0.876, 95% CI: 0.776-0.990) than those in illegal states. Women in recreational states were more likely to co-use marijuana and opioids than those in illegal (OR: 1.716) and medical states (OR: 2.530), and women in medical states were less likely to co-use compared to illegal states in 2017-2018 (OR: 0.633). In 2019, women in recreational states were less likely to co-use than those in illegal (OR: 0.613) or medical states (OR: 0.462). A Difference-in-Difference analysis showed that changing from medical to recreational marijuana policies had a small but significant impact on increasing marijuana use (B= 0.022, p<0.001) and decreasing opioid use (B= -0.022, p=0.004). Conclusion: Keeping in mind the limitations of this data, these findings indicate that perinatal substance use is influenced by state marijuana policies. As more states continue to legalize marijuana, understanding changes in substance use during pregnancy will help inform public policy and provide clinical guidance.

PREVALENCE OF MARIJUANA AND OPIOID USE DURING PREGNANCY IN THE UNITED STATES FROM 2017-2019

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