Psychiatric comorbidities and their treatment predict buprenorphine continuation among postpartum people with opioid use disorder

Association of Receipt of Opioid Prescription for Acute Post-Delivery Pain Management with Buprenorphine Discontinuation among Postpartum People with Opioid Use Disorder

“…Statistically significant differences between the curves were determined using the Wilcoxon-Breslow-Gehan test, a modified log-rank test that is sensitive to early differences. This decision to use a statistical test that is sensitive to early differences in the survival curves was informed by prior studies emphasizing that buprenorphine discontinuation at early timepoints (0-38 weeks) within the postpartum period are critical for clinicians to make timely interventions [2,5,16]. Cox proportional hazard models were used to assess associations between opioid prescription at delivery and time (in weeks) to postpartum buprenorphine discontinuation with and without adjusting for the covariates of incarceration status at delivery, psychiatric comorbidity, and the number of weeks maintained on buprenorphine before delivery; these factors were selected based on the prior literature indicating these variables' impacts on our outcomes and their ability to provide a holistic clinical context (albeit with a small, yet appropriate, number of variables given the sample size) for the adjusted model [5,17].…”

“…Although receiving care at the clinic was not a requirement for enrollment in the study, many individuals did receive care at OB MOTIVATE. The detailed methods for the parent study have been described previously [5], and the study was conducted with IRB approval from VCU. Briefly, participants were identified using the electronic medical record and included in the study if they had received a buprenorphine prescription at any point during their pregnancy and/or through one year postpartum.…”

“…The utilization of medications for OUD, especially when used for longer durations, is associated with 60% lower odds of opioid overdose death in the first year postpartum for individuals with OUD [3,4]. Unfortunately, reported postpartum MOUD discontinuation rates are high, between 36% [4] and 65% [5]. In one study of over 1500 birthing people diagnosed with OUD, 42.9% received buprenorphine treatment throughout their pregnancy; however, one third experienced a treatment disruption during the postpartum period [6].…”