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Low-dose buprenorphine initiation during pregnancy: a case report
Shivania Reddy1, Caitlin E Martin2,3
1School of Medicine, Virginia Commonwealth University, Richmond, VA (Ms Reddy).
AJOG Global Reports
|February 6, 2024
Summary
Low-dose buprenorphine initiation offers a new approach for pregnant patients with opioid use disorder, avoiding withdrawal symptoms. This method shows promise as an acceptable alternative treatment for opioid use disorder in pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Addiction Medicine
- Pharmacology
Background:
- Opioid use disorder (OUD) in pregnancy presents significant challenges for both the patient and the fetus.
- Buprenorphine is a recommended medication for OUD in pregnant individuals.
- Traditional buprenorphine initiation protocols often require patients to be in mild to moderate withdrawal to prevent precipitated withdrawal.
Observation:
- This study presents two cases of pregnant patients with OUD undergoing buprenorphine initiation.
- Case 1 involved a 30-year-old patient who experienced precipitated withdrawal during rapid inpatient initiation but tolerated low-dose initiation.
- Case 2 involved a 28-year-old patient who successfully underwent inpatient low-dose buprenorphine initiation, with plans for outpatient continuation.
Findings:
- Neither patient experienced precipitated withdrawal when using the low-dose buprenorphine initiation protocol.
- The low-dose protocol, utilizing split buprenorphine-naloxone films, was successfully implemented in both inpatient and outpatient settings.
- These cases suggest that low-dose buprenorphine initiation may be a viable and acceptable alternative for pregnant patients with OUD.
Implications:
- Low-dose buprenorphine initiation represents a potentially more acceptable and effective treatment strategy for pregnant patients with OUD.
- Further research is needed to establish optimal protocols and individualized approaches for buprenorphine initiation in pregnancy.
- This approach could improve treatment adherence and outcomes for pregnant individuals with OUD.
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