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Autonomous Care Pathway to Patient Opioid Abstinence: Should All Programs Offer this Approach?

October 1, 2021
Edition: Fall 2021
Volume: 36
Issue: 2
Article: 3

Table of Contents

Abstract

Introduction: The opioid epidemic resulted in vast increase in neonatal opioid withdrawal syndrome (NOWS). To mitigate NOWS and opioid dependency among women, staff established a gender specific, patient driven, autonomy based, outpatient therapeutic substitution program.

Methods: Prospective observational study of obstetric patients receiving prenatal care 7/1/2016-12/31/2019.  Patients underwent universal urine drug screens to identify illicit drug use with dependency and offered addiction counseling with voluntary outpatient therapeutic substitution in an obstetrical-addictions combined clinic to achieve abstinence with oral Buprenorphine tapering protocol.  Urine substance screening and cord blood testing were obtained at delivery. Birth outcomes compared among groups who achieved abstinence at birth, were successful at tapering, or continued opioid use.

Results: Of 783 births, 165 (20.9%) demonstrated opioid use with 91 (55.2%) participating at some point in pregnancy in therapeutic substitution program. At birth, 14/94 (14.9%) patients completed the program and achieved opioid abstinence, 22/94 (23.4%) still enrolled and actively tapering. 57/94 (34.5%) patients were lost to follow-up, relapsed, or terminated due to non-compliance. Seventy-four of 67 (44.3%) opioid positive mothers chose not to enroll. Of 14 women who completed the program, 0 babies born with NOWS, compared to 11/22 (50%) still enrolled in program and actively tapering, 29/57 (50.9%) lost to follow-up, relapsed, or terminated due to non-compliance, and 28/74 (37.8%) never enrolled in program.

Conclusion/Implications: Outpatient therapeutic substitution with oral Buprenorphine with abstinence is possible in pregnant patients and results zero NOWS.  More data are needed to confirm findings and explore methods for enhanced success in obtaining abstinence.

Support: Appalachian Regional Commission and Prevention (ARC) 1st through Charleston Area Medical Center in cooperation with Charleston Health Education and Research Institute (CHERI).

Keywords: Pregnancy, substance abuse, therapeutic substitution

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About the Authors

Affiliation: West Virginia University/Charleston Area Medical Center, Charleston, WV, United States
Affiliation: Charleston Area Medical Center (CAMC), Women’s Medicine Center, Charleston, WV United States
Affiliation: CAMC Health, Education, and Research Institute, Charleston WV, United States
Affiliation: Charleston Area Medical Center (CAMC), Women’s Medicine Center, Charleston, WV United States
Affiliation: CAMC Health, Education, and Research Institute, Charleston WV, United States
Affiliation: CAMC Health, Education, and Research Institute, Charleston WV, United States
Affiliation: West Virginia University of Osteopathic Medicine, Lewisburg, WV, United States
Affiliation: Byron Calhoun, MD, FACOG, FACS, FASAM, MBA, is a Professor and Vice-Chair of Obstetrics and Gynecology in the College of Medicine at the West Virginia University, Charleston, West Virginia. He is a diplomate of the American Board of Obstetrics and Gynecology with board certification in general Obstetrics and Gynecology and in the sub-specialty of Maternal-Fetal Medicine. He also is also board certified in Addictions Medicine.