Home Induction of Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy

Kelly, Jeannie C.; Raghuraman, Nandini; Stout, Molly J.; Russell, Sharman; Pérez, Marta; Nazeer, Sarah; Helou, Nicole El; Zhang, Fan; Carter, Ebony B.

doi:10.1097/aog.0000000000004539

Cited by 7 publications

(7 citation statements)

References 9 publications

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“…Our buprenorphine continuation rate of over 70% for all 3 COVID-19 phases is similar to or above the rate of other MOUD populations before COVID-19, 32 including postpartum patients 21,27 . One COVID-19–driven strategy that supported participant buprenorphine continuation was implementation of home buprenorphine induction, which has been found to be safe and effective among pregnant people 33 …”

Section: Discussionsupporting

confidence: 58%

“…21,27 One COVID-19-driven strategy that supported participant buprenorphine continuation was implementation of home buprenorphine induction, which has been found to be safe and effective among pregnant people. 33 Medical provider visit attendance decreased over the 3 COVID-19 phases yet remained relatively high; this is especially notable when considering the unique challenges pregnant and parenting people with SUD face. 14,34 We hypothesize that our expansion of patient-centered, recovery-oriented strategies, such as flexibility in visit type, contributed to the relatively high treatment engagement across the COVID-19 phases.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

et al. 2022

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ObjectiveThe COVID-19 pandemic prompted healthcare delivery changes, but the associated impacts on substance use disorder treatment outcomes among pregnant and parenting people are unknown. This study aims to (1) describe COVID-19–driven clinical practice changes, (2) evaluate clinic-level visit attendance patterns, and (3) compare patient-level treatment engagement outcomes across 3 COVID-19 pandemic phases in an OBGYN-addiction treatment clinic.MethodsCOVID-19 phases include pre–COVID-19 (August 2019–February 2020), early COVID-19 (March–December 2020), and COVID-19 vaccine (January–July 2021). OBGYN-addiction treatment clinical practice changes were summarized. Clinic-level attended medical provider visits were analyzed. Patient-level treatment engagement outcomes (buprenorphine continuation, visit attendance, and virtual visits) were assessed in a cohort of pregnant and parenting people enrolled in a clinic research registry. Mixed-level logistic regression models determined the relationship between the COVID-19 phases and the patient-level outcomes.ResultsThe study site made several COVID-19–driven clinical practice changes, including implementing a hybrid virtual/in-person system for medical visits. Clinic-level medical provider appointments increased between the first and second COVID-19 phases and remained high in the third phase. Among participants included in patient-level outcome analyses (N = 27), there were no differences in the early COVID-19 phase compared with the pre–COVID-19 phase in buprenorphine continuation, any visits, or medical visits. There was a decrease in all patient-level outcomes in the COVID-19 vaccine phase compared with pre–COVID-19 (P < 0.05). Virtual visits increased between the first 2 phases and remained high during the third.ConclusionWithin our OBGYN-addiction treatment clinic, implementation of tailored, patient-centered treatment strategies supported clinic- and patient-level treatment engagement throughout the pandemic.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

et al. 2022

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“…Typical induction protocols involve a washout period followed by observed or athome escalating doses of 2-4 mg of buprenorphine based on patient symptoms. This process is challenging for patients due to intolerance of withdrawal symptoms [35]. Importantly, the number of attempts required to initiate buprenorphine in pregnancy is associated with increased odds of poor pregnancy outcomes [36].…”

Section: Key Pointsmentioning

confidence: 99%

Pharmacotherapy for opioid use disorder in pregnancy

Trammel,

Whitley,

Kelly

2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Opioid use disorder (OUD) in pregnancy has significantly in the last decade, impacting 8.2 per 1000 deliveries. OUD carries significant risk of morbidity and mortality for both the birthing person and neonate, but outcomes for both are improved with opioid agonist treatment (OAT). Here, we describe the recommended forms of OAT in pregnancy, updates to the literature, and alternate OAT strategies, and share practical peripartum considerations for patients on OAT. Recent findings Recent studies comparing buprenorphine and methadone have reaffirmed previous findings that buprenorphine is associated with superior outcomes for the neonate, without clear differences in morbidity or mortality for the birthing person. Optimal initiation and dosing of OAT remains unclear, with several recent studies evaluating methods of initiation, as well as a potential role for higher and more rapid dosing in the fentanyl era. Alternative products such as buprenorphine-naloxone and extended-release buprenorphine are of significant research interest, though randomized prospective data are not yet available. Summary Buprenorphine and methadone are standard of care for treatment of OUD during pregnancy, and multiple patient factors impact the optimal choice. Insufficient data exist to recommend alternative agents as a primary strategy currently. All patients with OUD in pregnancy should be counseled regarding OAT. Video http://links.lww.com/COOG/A94

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“…Buprenorphine has been associated with less severe neonatal opioid withdrawal syndrome and is able to be prescribed in an office-based setting 2 . It is a partial opioid agonist, so traditional induction protocols recommend waiting until symptoms of moderate withdrawal are present before initiation to avoid precipitating withdrawal 4 . However, precipitated withdrawal from fentanyl can occur for up to a week after cessation 5 .…”

mentioning

confidence: 99%

“…2 It is a partial opioid agonist, so traditional induction protocols recommend waiting until symptoms of moderate withdrawal are present before initiation to avoid precipitating withdrawal. 4 However, precipitated withdrawal from fentanyl can occur for up to a week after cessation. 5 Given that withdrawal can be a deterrent to initiation or continuation of MOUD and has potential consequences during pregnancy, low-dose buprenorphine induction protocols have become more common.…”

mentioning

confidence: 99%

Low-dose Induction of Buprenorphine in Pregnancy: A Case Series

Junn,

Tugarinov,

Mark

2023

J Addict Med

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Background Because of a risk of precipitated withdrawal occurring from buprenorphine induction in people who use fentanyl, low-dose inductions are becoming increasingly common. However, little evidence exists on the use of this method in pregnant people. Methods We conducted a case series of all pregnant people treated for opioid use disorder with low-dose buprenorphine induction at the University of Maryland Medical Center between January 1, 2021, and August 22, 2022. Primary outcome was completion of induction regimen. Secondary outcomes were self-report of withdrawal, continuation of buprenorphine until delivery, and return to or continuation of illicit opioid use. Results Six pregnant people were prescribed a total of 10 buprenorphine inductions. Five of the 6 pregnant people (83.3%) completed at least 1 induction, none of whom experienced precipitated withdrawal. Two of 6 (33.3%) continued buprenorphine until the time of delivery, and 1 of 6 (16.7%) abstained from illicit opioid use. Conclusions The low-dose buprenorphine induction regimen described was successful in 5 of 6 pregnant individuals. Further research, particularly regarding continuation rates, is needed.

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Home Induction of Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy

Cited by 7 publications

References 9 publications

Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

Pharmacotherapy for opioid use disorder in pregnancy

Low-dose Induction of Buprenorphine in Pregnancy: A Case Series

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