57 Buprenorphine Initiation for Pregnant Patients With Opioid Use Disorder: A Multicenter Observational Study of California Bridge Sites

Abstract

Study objective: Opioid use disorder (OUD) diagnoses and overdose rates are increasing among pregnant women in parallel with the general population. Emergency departments (EDs) have emerged as critical sites for the initiation of treatment for OUD, but outcomes of ED initiated buprenorphine and linkage to care for pregnant women have not been described. Robust outpatient literature supports the safety of buprenorphine in pregnancy. However, no ED studies exist to support ED initiation of buprenorphine in pregnant patients. We aim to describe any differences in characteristics, treatment dosing, outcomes, and rates of linkage to care for pregnant women compared to non-pregnant women with OUD presenting to EDs funded by the California (CA) Bridge Program.MethodsThe CA Bridge model included low-threshold buprenorphine, linkage to care, and harm reduction technical support to EDs to improve treatment for OUD. This retrospective cohort study described pregnant and non-pregnant women of childbearing age with OUD who presented to 17 EDs between January and April of 2020. Primary outcome was linkage to substance use treatment within 14 days of ED discharge; secondary outcomes included descriptive characteristics, buprenorphine dosing, side effects, and complications.ResultsOf 250 women of childbearing age who presented to 17 EDs, 22 (6%) were pregnant. The median age of pregnant cohort was 29 (interquartile range [IQR]: 26-32) and 31 (IQR: 27-36) in non-pregnant cohort. 57% of each cohort were white. 29% in each cohort were unhoused. Among pregnant women 16 (76%) used heroin, and 4 (19%) used fentanyl; among non-pregnant women, 170 (74%) used heroin, and 24 (11%) used fentanyl. 38% of each cohort used intravenous drugs. A majority of pregnant (67%) and non-pregnant (89%) patients presented in opioid withdrawal or were seeking OUD treatment. A majority of pregnant and non- pregnant women accepted OUD resources (81% and 77%, respectively), and ED buprenorphine administration (67% and 59%, respectively). Among 14 pregnant women and 136 non-pregnant women who received sublingual buprenorphine, 71% and 89% (respectively) received an initial dose of 8mg or higher; 79% and 91% (respectively) received a total dose of 8mg or higher. Of the 250 patients, there was 1 case of precipitated opioid withdrawal, which occurred in a non-pregnant patient. 38% of pregnant women and 59% of non-pregnant women had buprenorphine prescribed at ED discharge. Within 2 weeks of discharge, 48% of pregnant women and 31% of non-pregnant women attended follow-up, and 48% of pregnant women and 34% of non-pregnant women confirmed still taking buprenorphine.ConclusionPregnant women with OUD who presented to EDs treated with CA Bridge protocols had similar characteristics, acceptance of treatment, dosing, treatment outcomes, and follow up rates as non-pregnant women. This data indicates that EDs can serve an important role for initiating buprenorphine for pregnant women.No, authors do not have interests to disclose Study objective: Opioid use disorder (OUD) diagnoses and overdose rates are increasing among pregnant women in parallel with the general population. Emergency departments (EDs) have emerged as critical sites for the initiation of treatment for OUD, but outcomes of ED initiated buprenorphine and linkage to care for pregnant women have not been described. Robust outpatient literature supports the safety of buprenorphine in pregnancy. However, no ED studies exist to support ED initiation of buprenorphine in pregnant patients. We aim to describe any differences in characteristics, treatment dosing, outcomes, and rates of linkage to care for pregnant women compared to non-pregnant women with OUD presenting to EDs funded by the California (CA) Bridge Program. MethodsThe CA Bridge model included low-threshold buprenorphine, linkage to care, and harm reduction technical support to EDs to improve treatment for OUD. This retrospective cohort study described pregnant and non-pregnant women of childbearing age with OUD who presented to 17 EDs between January and April of 2020. Primary outcome was linkage to substance use treatment within 14 days of ED discharge; secondary outcomes included descriptive characteristics, buprenorphine dosing, side effects, and complications. The CA Bridge model included low-threshold buprenorphine, linkage to care, and harm reduction technical support to EDs to improve treatment for OUD. This retrospective cohort study described pregnant and non-pregnant women of childbearing age with OUD who presented to 17 EDs between January and April of 2020. Primary outcome was linkage to substance use treatment within 14 days of ED discharge; secondary outcomes included descriptive characteristics, buprenorphine dosing, side effects, and complications. ResultsOf 250 women of childbearing age who presented to 17 EDs, 22 (6%) were pregnant. The median age of pregnant cohort was 29 (interquartile range [IQR]: 26-32) and 31 (IQR: 27-36) in non-pregnant cohort. 57% of each cohort were white. 29% in each cohort were unhoused. Among pregnant women 16 (76%) used heroin, and 4 (19%) used fentanyl; among non-pregnant women, 170 (74%) used heroin, and 24 (11%) used fentanyl. 38% of each cohort used intravenous drugs. A majority of pregnant (67%) and non-pregnant (89%) patients presented in opioid withdrawal or were seeking OUD treatment. A majority of pregnant and non- pregnant women accepted OUD resources (81% and 77%, respectively), and ED buprenorphine administration (67% and 59%, respectively). Among 14 pregnant women and 136 non-pregnant women who received sublingual buprenorphine, 71% and 89% (respectively) received an initial dose of 8mg or higher; 79% and 91% (respectively) received a total dose of 8mg or higher. Of the 250 patients, there was 1 case of precipitated opioid withdrawal, which occurred in a non-pregnant patient. 38% of pregnant women and 59% of non-pregnant women had buprenorphine prescribed at ED discharge. Within 2 weeks of discharge, 48% of pregnant women and 31% of non-pregnant women attended follow-up, and 48% of pregnant women and 34% of non-pregnant women confirmed still taking buprenorphine. Of 250 women of childbearing age who presented to 17 EDs, 22 (6%) were pregnant. The median age of pregnant cohort was 29 (interquartile range [IQR]: 26-32) and 31 (IQR: 27-36) in non-pregnant cohort. 57% of each cohort were white. 29% in each cohort were unhoused. Among pregnant women 16 (76%) used heroin, and 4 (19%) used fentanyl; among non-pregnant women, 170 (74%) used heroin, and 24 (11%) used fentanyl. 38% of each cohort used intravenous drugs. A majority of pregnant (67%) and non-pregnant (89%) patients presented in opioid withdrawal or were seeking OUD treatment. A majority of pregnant and non- pregnant women accepted OUD resources (81% and 77%, respectively), and ED buprenorphine administration (67% and 59%, respectively). Among 14 pregnant women and 136 non-pregnant women who received sublingual buprenorphine, 71% and 89% (respectively) received an initial dose of 8mg or higher; 79% and 91% (respectively) received a total dose of 8mg or higher. Of the 250 patients, there was 1 case of precipitated opioid withdrawal, which occurred in a non-pregnant patient. 38% of pregnant women and 59% of non-pregnant women had buprenorphine prescribed at ED discharge. Within 2 weeks of discharge, 48% of pregnant women and 31% of non-pregnant women attended follow-up, and 48% of pregnant women and 34% of non-pregnant women confirmed still taking buprenorphine. ConclusionPregnant women with OUD who presented to EDs treated with CA Bridge protocols had similar characteristics, acceptance of treatment, dosing, treatment outcomes, and follow up rates as non-pregnant women. This data indicates that EDs can serve an important role for initiating buprenorphine for pregnant women.No, authors do not have interests to disclose Pregnant women with OUD who presented to EDs treated with CA Bridge protocols had similar characteristics, acceptance of treatment, dosing, treatment outcomes, and follow up rates as non-pregnant women. This data indicates that EDs can serve an important role for initiating buprenorphine for pregnant women.