Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy

Andrea Nguyen; Hannah Shadowen; Caroline Shadowen; Bhushan Thakkar; Andrea K Knittel; Caitlin E Martin

doi:10.3389/fpsyt.2023.1157611

Incarceration status at buprenorphine initiation and OUD treatment outcomes during pregnancy

Front Psychiatry. 2023 Apr 13:14:1157611. doi: 10.3389/fpsyt.2023.1157611. eCollection 2023.

Authors

Andrea Nguyen¹, Hannah Shadowen², Caroline Shadowen³, Bhushan Thakkar³, Andrea K Knittel⁴, Caitlin E Martin^{3

5}

Affiliations

¹ School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
² Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States.
³ Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States.
⁴ Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
⁵ Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, VA, United States.

Abstract

Introduction: Opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients' incarceration status at the time of BUP initiation.

Methods: This is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status.

Results: Our sample included 76 patients, with 62% of patients incarcerated at BUP initiation (n = 47). Among the entire sample, 90.7% (n = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery (p = 0.02).

Conclusion: In our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.

Keywords: buprenorphine; incarceration; maternal health; opioid use disorder (OUD); perinatal.

Grants and funding

This study was supported by the Jeanann Gray Dunlap Foundation and partially by CTSA award no. UL1TR002649 from the National Center for Advancing Translational Sciences. CM was supported by NIDA award no. K23 DA053507. AK was supported by NICHD award K12HD103085 (PI Neal-Perry).