(199) Buprenorphine Treatment for Maternal Opioid Use Disorder: Differences between High and Low Retention Groups

Objective: Prevalence of maternal opioid use disorder (OUD) has substantially increased over the past decade. Medications for OUD are essential for effective treatment. Yet, factors that impact retention of opioid agonist treatment during pregnancy and beyond are poorly understood. Our objective was to examine differences in biopsychosocial factors between individuals with high versus low buprenorphine treatment retention.

Study Design: We used a prospective database from CARE, an interdisciplinary, wrap-around clinic providing prenatal, OUD, and extended postpartum care for patients with OUD at an urban tertiary care center. Data were analyzed from patients who received buprenorphine treatment (June 2018-August 2022), dichotomized into two groups of low (< 31 days of buprenorphine tx) and high (>32 days) retention. Differences between groups on demographics, medical, behavioral, and psychological variables were assessed via chi-square & independent samples t-tests.

Results: 79 patients were included for analysis; 63% identified as non-Hispanic White, 46% had a history of hepatitis C, and 72% had public insurance. ½ of patients fell into low and ½ into high retention groups. There were no differences in race, age, hepatitis c dx, time until buprenorphine induction, OUD length, polysubstance use, psychiatric tx, or anxiety/depression between groups. However, greater buprenorphine dosage at delivery, more clinic visits, and more behavioral health visits were found in the high retention group. No difference between groups was found when examining ratio of behavioral health to clinic visits.

Conclusion: Behavioral and medical factors differed between groups such that those who stayed on buprenorphine >31 days were more engaged with clinical and behavioral health care and had higher buprenorphine dosage at delivery. That the ratio of behavioral health to clinic visits did not significantly differ suggests that the cumulative amount of positive clinic contact may be more relevant than specific interventions. Results demonstrate the importance of treating OUD from a biopsychosocial and interdisciplinary perspective.