The Use of Once-monthly Injectable Buprenorphine for the Treatment of Opioid Use Disorder in Postpartum Women: A Case Series

Abstract

Objectives: For women with opioid use disorder (OUD), the postpartum period is an especially vulnerable period. Buprenorphine (BUP) improves OUD outcomes during this timeframe. Once-monthly injectable BUP (XRI-BUP) is a newer formulation for which evidence of use in postpartum women is extremely limited. We present a case series of 9 women who transitioned from sublingual (SL-BUP) to XRI-BUP in their first year postpartum. Methods: We conducted a retrospective chart review of our institution's medical record for patients who received at least one administration of XRI-BUP in their first year postpartum (January 2017–March 2020). Data were collected from baseline through mean follow-up of 281.4 days (range 235–417) for participant outcomes. Results: The most common indications for initiating XRI-BUP were participant preference (n = 9) followed by challenges taking SL-BUP (n = 6). Four of the 9 participants transitioned back from XRI- to SL-BUP during the study timeframe, for reasons including incarceration and undesired side effects. Preliminary treatment outcomes demonstrated that participants remained on SL- (n = 4) or XRI-BUP (n = 5) through follow-up. The 5 participants who remained on XRI-BUP had consistent negative urine drug tests for nonprescribed opioids during the study period. Conclusions: To our knowledge, this is the first study that reviews the feasibility of using XRI-BUP in postpartum women. Our results suggest that XRI-BUP is a viable treatment option, which should be further investigated in future studies of postpartum women with OUD.

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

“…The retrospective cohort study was approved by the University’s Institute Review Board. Methods for the parent study are described elsewhere ( Shadowen et al, 2021 ). Briefly, patients receiving buprenorphine at any point during pregnancy and/or through one year postpartum from January 2017 to March 2020 at an academic medical center were identified through a query of the electronic medical records.…”

“…Psychiatric conditions in the postpartum period are associated with poor outcomes for the parent-infant dyad, such as greater postpartum weight retention, worse physical health (weight retention, overall physical health), and poorer social function among postpartum parents with psychiatric conditions compared to parents without ( Vesga-Lopez et al, 2008 ; Slomian et al, 2019 ). In non-pregnant/postpartum samples, evidence for the relationship between psychiatric comorbidities and MOUD retention is mixed, with some studies suggesting that individuals with a psychiatric diagnosis are less likely to be retained in buprenorphine treatment and others finding that buprenorphine treatment retention is more likely among these individuals ( Slomian et al, 2019 ; O’Connor et al, 2018 ; Shadowen et al, 2021 ). Additionally, little is known about the impact of psychiatric treatment on MOUD retention in the postpartum period.…”

Pregnant and Postpartum Individuals' Knowledge, Attitudes, and Perceptions of Extended-release Buprenorphine for Treatment of Opioid Use Disorder

“…7 Several recently published case series suggest that XR-BUP may be well suited to meet the needs of postpartum individuals with OUD. [10][11][12] Furthermore, XR-BUP is not currently approved during pregnancy or lactation. The excipient, containing N-methyl-2pyrrolidone, has been linked to developmental abnormalities in rat studies at doses far above those in the commercially available XR-BUP preparation.…”

“…Among nonpregnant individuals, XR-BUP improves treatment retention and adherence compared with sublingual buprenorphine (SL-BUP) 7 . Several recently published case series suggest that XR-BUP may be well suited to meet the needs of postpartum individuals with OUD 10–12 …”

Postpartum Treatment of Individuals With Opioid Use Disorder: Maternal Risk and Need for Evidence Do Not End When Pregnancy Ends

“…In this issue of the Journal, Shadowen et al describe their center's experience using monthly extended-release buprenorphine (XR-BUP) for the treatment of OUD among women in the first year postpartum 6 . XR-BUP is currently available as Sublocade in only 2 doses (300 and 100 mg), with the higher dose recommended the first two months followed by monthly injections of 100 mg.…”