Adherence trajectories of buprenorphine therapy among pregnant women in a large state Medicaid program in the United States

Lo‐Ciganic, Wei‐Hsuan; Donohue, Julie M.; Kim, Joo Yeon; Krans, Elizabeth E.; Jones, Bobby; Kelley, David; James, A. Everette; Jarlenski, Marian

doi:10.1002/pds.4647

Cited by 46 publications

(36 citation statements)

References 39 publications

(96 reference statements)

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“…Our chosen medication use criteria were intended to limit this by only including individuals receiving a buprenorphine product indicated for OUD. (14,16,17) Although we excluded individuals changed residential ZIP code at any point while receiving buprenorphine, some individuals may have moved into the state in the six-months prior to initiating treatment leading to misclassification as incident users. Leaving the state would not be expected to impact exposure or outcome measurement as gaps and changes in pharmacy were recorded in the record after they had occurred.…”

Section: Discussionmentioning

confidence: 99%

“…The entire study duration was January 1, 2016-December 31, 2018. Index use of buprenorphine was defined by the initial prescription of a buprenorphine product indicated for opioid use disorder (14,16,17) during the identification period between June 30, 2016 and July 1, 2018. To ensure that only incident buprenorphine patients were included, we excluded individuals who used any buprenorphine product between January 1 and July 1, 2018.…”

Section: Study Design and Samplementioning

confidence: 99%

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Changes in pharmacy are associated with gaps in medication possession in individuals treated with buprenorphine

Varisco¹,

Abughosh²,

Chen³

et al. 2020

Preprint

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Objective: The objective of this study was to identify the prevalence of changes in pharmacy among incident buprenorphine users and to estimate the association between a change in pharmacy and a clinically significant gap in therapy of seven-days or longer. Methods: A repeated measures, cohort design was used to assess the association between changes in pharmacy and 7-day gaps in therapy. We first identified a cohort of patients with incident buprenorphine use from the Texas Prescription Monitoring Program. We then excluded those who filled less than three-prescriptions or completed less than seven-days of pharmacotherapy. From there, we lagged each patient’s previous pharmacy forward to determine if they changed pharmacies between subsequent prescription fills. A random intercept, fixed slope mixed model with a logistic link was then used to measure the association between a change in pharmacy and a gap in therapy. Results: Of 13,189 eligible patients, 29.5% had at least one change in pharmacy and 51.5% of those did so more than once. The median time to initial change in pharmacy was 30 (IQR:13-75) days. Patients who changed pharmacies were significantly more likely to have a gap in therapy between 7 and 29 days (aOR:1.96, 95% CI=1.81-2.13).Conclusion: Patients receiving buprenorphine based MOUD change pharmacies frequently and early in treatment which leads to clinically gaps in therapy. While qualitative explanatory work is needed to understand the reasons for such frequent changes in pharmacy, pharmacists and prescribers must both work to ensure that patients have reliable access to a convenient and reliable source of buprenorphine in order to prevent changes in pharmacy.

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Section: Discussionmentioning

confidence: 99%

Section: Study Design and Samplementioning

confidence: 99%

Changes in pharmacy are associated with gaps in medication possession in individuals treated with buprenorphine

Varisco¹,

Abughosh²,

Chen³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Studies have also described racial and ethnic disparities in the treatment of OUD 6,7 . Recent research is documenting a similar trend among pregnant women, with women of color being less likely to receive medication to manage OUD and more likely to experience inconsistent use or discontinuation 8,9 …”

Section: Racial and Ethnic Disparities In The Treatment Of Opioid Usementioning

confidence: 99%

Updates from the Literature, November/December 2020

Clark

2020

J Midwife Womens Health

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“…8 More recently, a retrospective cohort study of pregnant Medicaid recipients receiving buprenorphine demonstrated late initiation and discontinuation of medication during pregnancy is associated with the following factors: younger age, non-white race, residents of rural counties, fewer outpatient visits, more frequent emergency department visits, and hospitalizations, and lower buprenorphine daily dose. 9 The "fourth trimester" or first 12 weeks postpartum corresponds to a time of increased maternal stress due to the associated caretaking responsibilities of a newborn child. This stress and other associated stressors, such as time and financial constraints, are possible reasons for treatment discontinuation during the postpartum period.…”

Section: Introductionmentioning

confidence: 99%

“…Our group recently published a study that identified risk factors for treatment adherence during pregnancy until delivery and found that higher clinically rated withdrawal symptoms at last visit attended and lower daily buprenorphine doses were associated with nonadherence 8 . More recently, a retrospective cohort study of pregnant Medicaid recipients receiving buprenorphine demonstrated late initiation and discontinuation of medication during pregnancy is associated with the following factors: younger age, non‐white race, residents of rural counties, fewer outpatient visits, more frequent emergency department visits, and hospitalizations, and lower buprenorphine daily dose 9 …”

Section: Introductionmentioning

confidence: 99%

Buprenorphine Medication for Opioid Use Disorder: A Study of Factors Associated With Postpartum Treatment Retention

et al. 2020

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Background and Objectives: The factors associated with medication for opioid use disorder (MOUD) treatment retention among pregnant women with opioid use disorder (OUD) are largely unknown. This study sought to characterize factors associated with postpartum treatment retention. Methods: A retrospective chart review from 2014 to 2017 was conducted among women with OUD in pregnancy treated with buprenorphine. Women were assigned to the treatment retention group if they attended an appointment within 10 to 14 weeks postpartum. Others were assigned to the dropout group. The groups were compared using bivariate analysis for sociodemographic variables, obstetrical and neonatal outcomes, clinical and subjective opioid withdrawal symptoms, buprenorphine dosage, urine drug toxicology (UDT) results, and other factors. Results: A total of 64 pregnancies received treatment until delivery, and 47 (73.1%) were retained in treatment by 12 weeks postpartum. The treatment dropout group had lower buprenorphine doses at delivery, a higher percentage of benzodiazepine positive UDT, and number of UDT positive for benzodiazepine in the third trimester. Breastfeeding rates were higher in the treatment retention group. Discussion and Conclusions: Future research of variables related to postpartum treatment retention is needed to provide guidelines regarding MOUD during the perinatal period and to optimize maternal and fetal well-being. Scientific Significance: This study supports previous recommendations that aggressive treatment of withdrawal symptoms in pregnant women with OUD is needed to maximize treatment retention. This is the first study to find that breastfeeding was associated with postpartum treatment retention; while, increased use of benzodiazepines during pregnancy was associated with postpartum treatment dropout.

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Adherence trajectories of buprenorphine therapy among pregnant women in a large state Medicaid program in the United States

Cited by 46 publications

References 39 publications

Changes in pharmacy are associated with gaps in medication possession in individuals treated with buprenorphine

Changes in pharmacy are associated with gaps in medication possession in individuals treated with buprenorphine

Updates from the Literature, November/December 2020

Buprenorphine Medication for Opioid Use Disorder: A Study of Factors Associated With Postpartum Treatment Retention

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