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

Ray-Griffith, Shona; Tharp, Emily; Coker, Jessica L; Catlin, David; Knight, Bettina T.; Stowe, Zachary N.

doi:10.1111/ajad.13084

Cited by 12 publications

(12 citation statements)

References 12 publications

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“…Risk factors for MOUD treatment non-retention during pregnancy and the postpartum period include non-White race, younger age, alcohol and drug use/use disorders, missing healthcare appointments, and MOUD-related factors, such as lower duration or dose of treatment prior to delivery ( 9 – 12 ). Qualitative studies have identified additional retention barriers of parenting stress, mood disorders, discrimination for prenatal substance use, shame about having a substance-exposed infant, lack of autonomy over treatment decisions, and scrutiny from child welfare ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

et al. 2023

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BackgroundWhile medications for opioid use disorder (MOUD) effectively treat OUD during pregnancy and the postpartum period, poor treatment retention is common. Digital phenotyping, or passive sensing data captured from personal mobile devices, namely smartphones, provides an opportunity to understand behaviors, psychological states, and social influences contributing to perinatal MOUD non-retention. Given this novel area of investigation, we conducted a qualitative study to determine the acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder (PPP-OUD).MethodsThis study was guided by the Theoretical Framework of Acceptability (TFA). Within a clinical trial testing a behavioral health intervention for PPP-OUD, we used purposeful criterion sampling to recruit 11 participants who delivered a child in the past 12 months and received OUD treatment during pregnancy or the postpartum period. Data were collected through phone interviews using a structured interview guide based on four TFA constructs (affective attitude, burden, ethicality, self-efficacy). We used framework analysis to code, chart, and identify key patterns within the data.ResultsParticipants generally expressed positive attitudes about digital phenotyping and high self-efficacy and low anticipated burden to participate in studies that collect smartphone-based passive sensing data. Nonetheless, concerns were noted related to data privacy/security and sharing location information. Differences in participant assessments of burden were related to length of time required and level of remuneration to participate in a study. Interviewees voiced broad support for participating in a digital phenotyping study with known/trusted individuals but expressed concerns about third-party data sharing and government monitoring.ConclusionDigital phenotyping methods were acceptable to PPP-OUD. Enhancements in acceptability include allowing participants to maintain control over which data are shared, limiting frequency of research contacts, aligning compensation with participant burden, and outlining data privacy/security protections on study materials.

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Section: Introductionmentioning

confidence: 99%

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

et al. 2023

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“…Randomized trials of both buprenorphine and methadone have found no relationship between dose and adverse outcomes such as total morphine needed to treat NOWS, neonatal hospital stay, duration of NOWS treatment, estimated gestational age at delivery, 5-minute APGAR, or newborn anthropometric measurements [ 21 , 22 ]. Rather, higher buprenorphine doses are associated with higher levels of treatment retention during pregnancy and postpartum [ 20 , 23 , 24 ]. Although initial dose did not predict discharge dose, the more clinically significant outcomes are number of dose adjustments and length of stay, as these could influence patient withdrawal, reflect more complicated inductions, and potentially contribute to patients leaving against medical advice due to the difficulty and discomfort of reaching a stable dose.…”

Section: Discussionmentioning

confidence: 99%

“…High rates of incarceration are seen elsewhere in the literature, with 29.3% of patients in one study having current legal involvement and 23% lost to follow up. Those lost to follow up were more likely to have legal involvement 30 days prior to cohort enrollment [ 23 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Inpatient Buprenorphine Induction for Opioid Use Disorder in Pregnancy

Tavakoli¹,

Donovan²,

Sweeney³

et al. 2023

Cureus

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Buprenorphine is a commonly used medication to manage opioid use disorder, however there is limited data to guide induction protocols specifically during pregnancy. Similar to non-pregnant patients the Clinical Opiate Withdrawal Scale (COWS) is often used to guide induction and titration of buprenorphine in pregnancy. The objective of this retrospective descriptive study is to assess the inpatient buprenorphine induction patterns, treatment retention, and pregnancy outcomes among obstetric patients with opioid use disorder seeking treatment. Study designThis was a retrospective study of obstetric patients with opioid use disorder admitted for inpatient buprenorphine induction at a large academic center between May 2015 to 2020. A descriptive analysis of the cohort, induction patterns, and dose retention after discharge were evaluated in addition to obstetric and neonatal outcomes. ResultsSixty patients were admitted for inpatient buprenorphine induction at a median gestational age of 16.7 weeks. The median COWS score on presentation was 9. The starting dose for half of the patients (30 out of 60 patients) was 8 mg of buprenorphine, while 24 patients were started at 4 mg. The median duration of hospitalization was three days (range 2-12). The median buprenorphine dose upon discharge was 10 mg (range 4-20). Only 13 of the 35 patients (37%) who desired prenatal care at our institution returned to receive routine prenatal care. Of the 12 (20%) patients who delivered at our institution, nine were live births (75%). Among the live births, the median gestational age at delivery was 37.4 weeks, birth weight 3085 grams, and only one (8%) developed neonatal abstinence syndrome. ConclusionWhen using the Clinical Opiate Withdrawal Scale to guide inpatient buprenorphine titration for pregnant patients with opioid use disorder it takes approximately three days to establish a satisfactory maintenance dose with the median dose at discharge in this population being 10 mg. The majority of patients who followed up after hospital discharge did not need dose adjustments.

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“…Supportive, nonjudgmental relationships with service providers can be motivators for persons to make positive changes in their substance use during pregnancy (Ray-Griffi th et al, 2021). Nurses who provide unbiased guidance and support, particularly during the critical postpartum period, can encourage positive nurse-patient rapport, strengthen parent-infant bonding, and promote continued substance use treatment beyond pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Health Care Experiences During Pregnancy and Parenting with an Opioid Use Disorder

Kim

Busse

Kantrowitz‐Gordon

et al. 2022

McN: The American Journal of Maternal/Child Nursing

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Purpose:The purpose of this study was to describe the experience of individuals with opioid use disorder (OUD) during the perinatal period.Study Design and Methods:We convened focus groups of patients with OUD who had been pregnant and were parenting. Participants who were 18 and older, English-speaking, self-identified as pregnant or parenting, and actively using opioids or in recovery from OUD were recruited using snowball and convenience sampling in resident treatment facilities and outpatient settings. Data were recorded, transcribed, and analyzed for themes.Results:Twenty-four participants were recruited, 10 of whom were actively receiving residential recovery services. Most participants had been pregnant from 4 weeks to 2 years prior to our focus group session; none reported being currently pregnant. Nineteen participants had custody of some, or all, of their children. They identified four key themes related to their care: (1) disrespectful care, (2) fear of accessing services, (3) inconsistencies in care received, and (4) limited health and social services.Clinical Implications:Participants reported overall negative interactions across different health care settings and lack of social resources to promote ongoing recovery and successful parenting. Nurses should be aware of the lasting impressions they have on their patients. Recognition of their own biases, person-first language, and partnership building skills with patients can help attenuate OUD stigma, promote positive nurse–patient relationships, and support new parents in recovery and infant bonding.

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

Cited by 12 publications

References 12 publications

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

Prospective acceptability of digital phenotyping among pregnant and parenting people with opioid use disorder: A multisite qualitative study

Inpatient Buprenorphine Induction for Opioid Use Disorder in Pregnancy

Health Care Experiences During Pregnancy and Parenting with an Opioid Use Disorder

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