877 Inpatient buprenorphine induction for opioid use disorder in pregnancy

Abstract

Buprenorphine is used for opioid use disorder but there is limited data to guide induction protocols in pregnancy. A protocol for inpatient buprenorphine induction with titration based on Clinical Opiate Withdrawal Scale (COWS) scores was initiated at our institution in 2015. The purpose of this study is to assess the inpatient buprenorphine induction patterns, treatment retention, and pregnancy outcomes among obstetric patients with opioid use disorder seeking treatment. Obstetric patients with opioid use disorder admitted for inpatient buprenorphine induction between May 2015 to 2020 were studied retrospectively. A descriptive analysis of the cohort, induction patterns, and retention after discharge evaluated. Among patients delivered at our institution obstetric and neonatal outcomes were assessed. 60 patients were admitted for inpatient buprenorphine induction at a median gestational age of 16.7 weeks. The median COWS on presentation was 9. Most patients were initiated on 8 mg buprenorphine (30), while 24 were started at 4 mg. 22 patients had no additional withdrawal symptoms day one while 21 patients required a supplemental 2 mg dose. The median duration of hospitalization was 3 days (range 2-12). The median buprenorphine dose upon discharge was 10 mg (range 4-20). Of the 12 patients with birth outcomes, 3 were on a different dose at delivery; 2 decreased dose and 1 switched to methadone. Only 13 of the 35 patients (37%) who desired prenatal care at our institution returned. Of the 12 (20%) patients who delivered at our institution, 9 were live births (75%). Among the live births, the median gestational age at delivery was 37.4 weeks, birthweight 3085 grams, and only 1 developed neonatal abstinence syndrome. The Clinical Opiate Withdrawal Scale can be used to guide inpatient buprenorphine titration for pregnant patients with opioid use disorder which takes approximately three days to establish a satisfactory maintenance dose of 10 mg. The majority of patients who followed up after hospital discharge did not need dose adjustments and had good outcomes.