Location of buprenorphine initiation and opioid use disorder treatment outcomes during pregnancy

Abstract

Opioid use disorder (OUD) is a major contributor to maternal morbidity and mortality, largely during the one-year postpartum period. Medication treatment reduces overdose risk and improves perinatal outcomes. Our study aimed to assess the association of the location of buprenorphine initiation (inpatient versus outpatient) with buprenorphine continuation through one year postpartum among a cohort of pregnant people with OUD. We performed a retrospective cohort study comparing rates of buprenorphine continuation through 52 weeks postpartum among a cohort of pregnant people cared for at an academic medical center (2017 – 2020) where both inpatient and outpatient buprenorphine initiation is offered. Medical record abstractions were conducted in pregnancy through one year postpartum. Exposure of interest was location of buprenorphine initiation (inpatient versus outpatient). Primary outcome was postpartum week of buprenorphine discontinuation. Bivariate analyses, Kaplan Meier survival curves, and Cox Proportional Hazard models were used. Our cohort included 116 patients, 77 initiating buprenorphine inpatient and 39 initiating outpatient. Most were insured by Medicaid (73%), lacked college education (55%), and had comorbid mental health conditions (71%) and substance use disorder (69%). Median gestational age at delivery was 39 weeks (Table 1). Outpatient initiation of buprenorphine during pregnancy was negatively associated with buprenorphine discontinuation in the postpartum period, with HR 0.63 (95% CI 0.38-1.03) (Figure 1). In our cohort, postpartum buprenorphine continuation outcomes were similar across initiation clinical settings. Outpatient initiation was marginally associated with longer postpartum buprenorphine duration, likely due to selection bias. Our observational cohort was small; findings should be interpreted with caution. Nonetheless, results illustrate need for further investigation into how perinatal clinical systems can expand access to life-saving treatments for OUD, such as by providing flexibility in how patients can engage in treatment.View Large Image Figure ViewerDownload Hi-res image Download (PPT)