Prenatal treatment for opioid dependency: observations from a large inner-city clinic

Abstract

BackgroundThe objective of this study was to review changes in the prevalence of opioid use disorder in pregnancy, and to describe the prenatal care and neonatal outcomes following the implementation of buprenorphine treatment at a large US obstetrical clinic during the on-going opioid epidemic. MethodsWe conducted a retrospective cohort study of 310 women (332 pregnancies) with opioid use disorders and their neonates delivered between June 2006 and December 2010 at an obstetrical clinic in the US. Trends in patient volume, characteristics and outcomes by calendar year were assessed using the Cochran–Armitage test and linear regression.ResultsThere was an almost two-fold increase in the volume of pregnant women treated annually from 2006 through 2010. Most women were treated with methadone (74%), with buprenorphine becoming more common over calendar time: 3.0% in 2006 to 41% in 2010. The mean dose of buprenorphine at delivery was: 11.4 mg in 2007, 14.1 mg in 2008, 14.1 mg in 2009, and 16.8 mg in 2010; an average increase of 2.1 mg year. There were no differences in mean methadone dose over time. From 2006 to 2010 there were increases in the prevalence of prescribed concomitant psychotropic medications and vaginal deliveries, and in the proportion of neonates treated pharmacologically for neonatal abstinence syndrome (NAS). NAS pharmacologic management also varied by calendar year with more use of neonatal morphine and clonidine in later years.ConclusionsThe number of mother–infant pairs increased significantly from 2006 to 2010 and the clinical characteristics of these patients changed over time. Our experience reflects the rising increase in opioid use disorders in pregnancy and NAS, mandating the need for expansion of comprehensive prenatal care options for these women and their children.

Prenatal Treatment and Outcomes of Women With Opioid Use Disorder

“…Buprenorphine treatment failure, described as transition to methadone because of continued opioid use or relapse, occurred in 22.0% of the study cohort, which is higher than the rate of 1.5% observed at our clinic from 2006 through 2010 25 . This may reflect changes in the clinic protocol to offer buprenorphine as a treatment option, even for women with higher risk profiles, in an effort to expand buprenorphine access and increase patient autonomy.…”

Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated With Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population

“…Our higher rates may partly be attributed to the implementation of Project Recovery, Empowerment, Social Services, Prenatal Care, Education, Community, and Treatment (RESPECT) at BMC in 2006. 37 This program identified and treated pregnant women with substance use disorder and their children, who were subsequently delivered at BMC.…”

Epigenetic variation in OPRM1 gene in opioid‐exposed mother‐infant dyads

“…Boston Medical Center (BMC) is a tertiary‐care urban medical center with a specialized prenatal program called Project RESPECT for women with substance use disorders. All women in Project RESPECT are on methadone or buprenorphine medication‐assisted treatment . BMC practices a rooming‐in model of care for these mother‐infant dyads where infants are kept with their mothers on the postpartum unit maternal discharge and then they are transferred to the inpatient pediatric unit for continued monitoring and NAS treatment …”