Methadone and Buprenorphine Discontinuation among Postpartum Women with Opioid Use Disorder.

BACKGROUND: The postpartum year is a vulnerable period for women with opioid use disorder, with increased rates of fatal and non-fatal overdose, yet the continuation of the use of medications to treat opioid use disorder (MOUD) on a population-level remains unknown.

OBJECTIVES: To examine the discontinuation of methadone and buprenorphine among women with opioid use disorder in the year following delivery and determine the extent to which maternal and infant characteristics are associated with time to discontinuation of MOUD.

STUDY DESIGN: Population-based retrospective cohort study using linked administrative data of 211,096 deliveries in Massachusetts between 2011-2014 to examine MOUD receipt. Individuals receiving MOUD the month of delivery were included in the study. Demographic, psychosocial, prenatal, and delivery characteristics are described. Kaplan-Meier survival analysis and Cox regression modeling were used to examine factors associated with treatment discontinuation.

RESULTS: There were 2,314 women included who received MOUD at delivery; 64.1% (1,484) continued receiving MOUD for a full 12 months following delivery. The continuation rate varied from 34% if women started on medication the month before delivery to 80% if medications were used all of pregnancy. Kaplan-Meier survival curves differed by maternal race/ethnicity (white non-Hispanic 12-month continuation probability 0.65 compared with non-white women was 0.51, p<0.001) and duration of prenatal MOUD utilization (12-month continuation probability was 0.78 for full prenatal engagement compared with 0.60 and 0.44 for those receiving 5 or more months (but not all of pregnancy) and 4 or fewer months of MOUD prenatally, respectively p<0.001). In all multivariable models, duration of prenatal MOUD receipt (4 months or fewer v. all pregnancy: aHR 3.26, 95% CI 2.72-3.91) and incarceration (incarceration during pregnancy or postpartum period v. none: aHR 1.79 (95% CI 1.52-2.12) were most strongly associated with MOUD discontinuation.

CONCLUSIONS: Almost two-thirds of women with OUD remained on MOUD for the full year postpartum, but rates varied significantly by race/ethnicity, degree of prenatal MOUD utilization, and incarceration status. Prioritizing treatment continuation across the perinatal continuum, enhancing gender-specific and family friendly recovery supports, and expanding access to MOUD while incarcerated can help improve postpartum treatment receipt.