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Inpatient Buprenorphine Induction for Opioid Use Disorder in Pregnancy.

Amin Tavakoli1, Kelly Donovan1, Heather Sweeney1

  • 1Obstetrics and Gynecology, Los Angeles County University of Southern California Medical Center, Los Angeles, USA.

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This study shows that using the Clinical Opiate Withdrawal Scale (COWS) for inpatient buprenorphine induction in pregnant patients with opioid use disorder takes about three days. The median discharge dose was 10 mg, with most patients not needing adjustments after leaving the hospital.

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buprenorphinemedication for opioid use disorder (moud)neonatal opioid withdrawal syndromeopioid use disorder (oud)opioid withdrawal

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Area of Science:

  • Obstetrics and Gynecology
  • Addiction Medicine
  • Pharmacology

Background:

  • Opioid use disorder (OUD) in pregnancy presents unique challenges for treatment.
  • Buprenorphine is a key medication for OUD, but specific induction protocols for pregnant individuals are not well-established.
  • The Clinical Opiate Withdrawal Scale (COWS) is frequently used to guide buprenorphine induction and titration in pregnant patients, similar to non-pregnant populations.

Purpose of the Study:

  • To assess inpatient buprenorphine induction patterns in obstetric patients with opioid use disorder.
  • To evaluate treatment retention and pregnancy outcomes following inpatient buprenorphine induction.
  • To analyze the effectiveness of the COWS scale in guiding buprenorphine titration during pregnancy.

Main Methods:

  • Retrospective descriptive study of obstetric patients with OUD undergoing inpatient buprenorphine induction.
  • Data collected from May 2015 to 2020 at a large academic center.
  • Analysis included cohort characteristics, induction patterns, post-discharge dose retention, and obstetric/neonatal outcomes.

Main Results:

  • Sixty patients were included, with a median gestational age of 16.7 weeks at admission.
  • The median COWS score was 9; starting doses varied (4 mg or 8 mg), with a median discharge dose of 10 mg.
  • Hospitalization lasted a median of three days. Of those delivering at the institution, 75% had live births, with only one neonate developing neonatal abstinence syndrome.

Conclusions:

  • Inpatient buprenorphine induction using the COWS scale for pregnant patients with OUD requires approximately three days to achieve a stable maintenance dose.
  • The median discharge buprenorphine dose for this population was 10 mg.
  • Most patients who followed up post-discharge did not require further dose adjustments, suggesting the established dose was satisfactory.