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Buprenorphine Dosing for the Treatment of Opioid Use Disorder Through Pregnancy and Postpartum

  • Substance Use Disorders (FG Moeller, Section Editor)
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Abstract

Purpose of review

Opioid-related deaths are a leading cause of mortality during pregnancy through 12 months postpartum. Buprenorphine use during pregnancy is increasing, yet expert opinion on its dosing through the perinatal period is limited. We provide a review of the current clinical literature on buprenorphine dosing during pregnancy through 12 months postpartum and present data from a retrospective chart review of patients at our institution describing trends in buprenorphine dosing during pregnancy and postpartum. Utilizing this information, we synthesize findings to provide clinical recommendations for providers.

Recent findings

Existing literature during pregnancy reflects how many women increase and split total daily buprenorphine doses as gestational age advances.

Summary

We present data from a retrospective chart review of patients at our institution describing trends in buprenorphine dosing during pregnancy and postpartum. Utilizing this information, we synthesize findings to provide clinical recommendations for providers. Changes in the total daily dose of buprenorphine used across pregnancy and through 12 months postpartum at the individual level do not follow consistent patterns, highlighting substantial individual variability. Altogether, buprenorphine dosing should be individualized through pregnancy and postpartum with frequent evaluations by providers and solicited input from patients.

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Data Availability

Data was obtained from the VCU medical record, and anonymous level data are available upon request.

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Papers of particular interest, published recently, have been highlighted as: • Of importance

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Acknowledgment

The authors wish to thank Dr. Stephen Strakowski for reviewing the manuscript and Jingmei (Emily) Song for assistance with data analysis.

Funding

This study was supported by UL1TR002649 and U54DA038999 as well as KL2TR002648.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Box no. 980034, 1250 E. Marshall St., Richmond, VA, 23298, USA

    Caitlin E. Martin MD, MPH

  2. School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA

    Caroline Shadowen BA

  3. Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA

    Bhushan Thakkar PT, MS

  4. Clinical Research Informatics Group, C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA

    Travis Oakes BS

  5. Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA

    Tamas S. Gal MBA, PhD

  6. Department of Psychiatry, Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA

    F. Gerard Moeller MD

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  1. Caitlin E. Martin MD, MPH
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  2. Caroline Shadowen BA
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  3. Bhushan Thakkar PT, MS
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  4. Travis Oakes BS
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  5. Tamas S. Gal MBA, PhD
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  6. F. Gerard Moeller MD
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Caitlin E. Martin, Caroline Shadowen, Bhushan Thakkar, Travis Oakes, and Tamas S. Gal. The first draft of the manuscript was written by Caitlin E. Martin and Caroline Shadowen with guidance from F. G. Moeller. All authors commented on subsequent versions of the manuscript as well as read and approved the final manuscript.

Corresponding author

Correspondence to Caitlin E. Martin MD, MPH.

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Conflict of Interest

Dr. F. Gerard Moeller has research funding from Indivior Pharmaceuticals and Nektar Therapeutics and is a consultant for Astellas and Individor for work unrelated to this study. The authors have no other conflicts of interest.

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Database queries were run against customized VCU data and are available upon request.

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Martin, C.E., Shadowen, C., Thakkar, B. et al. Buprenorphine Dosing for the Treatment of Opioid Use Disorder Through Pregnancy and Postpartum. Curr Treat Options Psych 7, 375–399 (2020). https://doi.org/10.1007/s40501-020-00221-z

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