Background: Advanced practice providers (APPs; midwives, nurse practitioners, physician associates) are key players in delivering high-quality care to maternity patients with opioid use disorder (OUD). Yet, these providers describe notable ethical conflict related to drug testing and child welfare reporting decisions for these patients. Linked to provider burnout and poor patient outcomes, this ethical conflict requires empirical exploration and contextualization within its provider-level and policy-level correlates. Purpose: Drawing from bioethics frameworks and informed by a systematic qualitative literature review, the purpose of this observational study was to: 1) quantify ethical conflict among maternity APPs related to drug testing and reporting for their maternity patients with OUD; and 2) explore the influence of provider-level and policy-level factors on this ethical conflict. Methods: Maternity APPs across the US (N=171) completed a cross-sectional survey, adapted from Falcó-Pegueroles’ Ethical Conflict in Nursing Questionnaire measuring exposure to and type of ethical conflict experienced in clinical scenarios about drug testing and reporting for maternity patients with OUD. Measures capturing provider-level (stigma and moral sensitivity) and policy-level (state laws and institutional) factors were included. Descriptive statistics and general linear regression modeling were employed. Results: Findings suggest that providers who practice as midwives; work across both outpatient/inpatient settings; practice in the South (vs Northeast); and do not have children are most vulnerable to ethical conflict related to drug testing and reporting decisions. Higher levels of stigma predicted lower exposure to ethical conflict while discretionary drug testing practices predicted higher exposure when compared to universal drug testing practices. The differential effect of state laws addressing maternal drug use across various clinical scenarios reflects the legal-ethical interplay between maternal and child needs. Implications: Stigma-reduction training and changes to testing or reporting policies for maternity patients must concurrently address the ethical conflict experienced by APPs. Clarifying predictors of APPs’ ethical conflict as they navigate these challenging decisions is essential to support these providers and, ultimately, improve care for mothers with OUD and their children.