Psychiatric Comorbidities and Their Treatment Predict Buprenorphine Continuation Among Postpartum People With Opioid Use Disorder

Authors

Hannah Shadowen
Stephanie Violante
Andrea Gataric
Alison N Goulding
Caitlin E Martin

Publication Date

12-1-2022

Journal

Drug and Alcohol Dependence Reports

DOI

10.1016/j.dadr.2022.100121

PMID

36644222

PMCID

PMC9835555

PubMedCentral® Posted Date

11-19-2022

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Opioid use disorder, Postpartum, Perinatal, Mental illness

Abstract

BACKGROUND: Opioid use disorder (OUD) is a growing crisis among pregnant and postpartum people. Psychiatric comorbidities are common, yet how they impact OUD treatment outcomes is not well characterized. The aim of this study was to assess the association of psychiatric comorbidities and receipt of psychiatric treatment with buprenorphine continuation through one year postpartum among a sample of people with OUD.

METHODS: A subsample was identified from a larger retrospective cohort of patients receiving buprenorphine for OUD at the time of delivery from an academic medical center between 2017 and 2020. Medical record abstractions were conducted during pregnancy through one year postpartum. Independent variables included any psychiatric diagnosis and postpartum receipt of psychiatric treatment (medication or behavioral health). The primary outcome was week of buprenorphine discontinuation. Cox Proportional Hazard models were used.

RESULTS: Of 138 patients, 71.8% had a psychiatric condition and 35.5% continued buprenorphine for a full year postpartum. Postpartum buprenorphine continuation was associated with (a) Psychiatric co-morbidity (buprenorphine discontinuation HR 0.49; 95% CI 0.29, 0.82), (b) Receipt of psychiatric medications in weeks 39-52 postpartum (buprenorphine discontinuation HR 0.21; 95% CI 0.06, 0.83), and (c) Receipt of behavioral health therapy in weeks 9-38 postpartum (buprenorphine discontinuation HR 0.40; 95% CI 0.18, 0.90).

CONCLUSION: Our work suggests a dynamic relationship between OUD treatment outcomes, psychiatric comorbidities and receipt of psychiatric treatments through the highly vulnerable postpartum period. Clinicians and researchers alike should work to advance patient-centered engagement in integrated care models tailored for this unique population.