Buprenorphine treatment during the extended postpartum period: a survey of patient experiences

The late postpartum period, defined as greater than 6 weeks to 12 months, is a high-risk time for individuals with opioid use disorder (OUD). Discontinuation rates of buprenorphine treatment for OUD during this period are high. Little is known about patients' subjective experience with buprenorphine treatment during this time. We sought to assess patient treatment experience, goals, facilitators and barriers to continued buprenorphine treatment throughout the extended postpartum period.

We performed a cross-sectional survey of postpartum patients who received buprenorphine treatment, including sublingual and long-acting injectable formulations, in an interdisciplinary, wrap-around clinic for maternal OUD between February 2022 through May 2023. Individuals participated in a brief electronic questionnaire comprised of multiple choice, Likert scale and open-ended questions adapted from validated surveys. Individuals were recruited to participate at each of three separate time points postpartum; <6 weeks, ≥6 weeks to 3 months, and >3 months. Descriptive statistics, Fisher exact, the Cochran-Armitage trend and chi-squared tests were used to describe survey results.

Fifty individuals were approached to participate in the survey, of which 25 unique postpartum individuals participated. This captured a total of 37 responses amongst all three time points. At the time of final survey completion, the average individual was 10.68 months (SD ± 7.13) postpartum. 76% self-identified as white and 24% Black or African American. The majority (88%) were prescribed sublingual buprenorphine. Most (84%) had been prescribed buprenorphine for more than three months at the time of initial survey completion. The majority (89%) of responses across all time points reported being very satisfied or satisfied with their current treatment, being satisfied with the effectiveness of their buprenorphine in reducing opioid use (98%) and with the effectiveness at reducing other substance use (54%). Top motivators for continuing treatment included individual health, ability to care for child(ren), and social support of friends or family. No differences were detected across time points. Surprisingly, the most often reported treatment goal was to discontinue buprenorphine eventually (49% of all responses). Most strongly agreed or agreed with the following statements about social supports, including that they know they take buprenorphine (100%), support their decision to take buprenorphine (89%), believe it is treatment for OUD (78%), and want them to continue treatment (78%). However, fewer (41%) strongly agreed or agreed with the following statement: the people I am close to want me to continue buprenorphine treatment long term (i.e. several years). Less than half (46%) agreed with the statement, the people I am close to know what it takes to stay sober. Barriers to buprenorphine treatment were infrequently reported (12%) but included sizable challenges including COVID-19 infection, lack of transportation and unstable housing.

During the extended postpartum period, majority of patients described treatment satisfaction with buprenorphine as overwhelmingly positive regardless of formulation. However, despite this, individuals most often reported goals to discontinue treatment, particularly during the late postpartum period. And individuals reported social supports disagreed with continuing buprenorphine treatment long term (i.e. several years). These findings highlight the need for stronger reinforcement of buprenorphine as a treatment for a chronic condition during the extended postpartum period, with an emphasis on educating and involving social supports in the process.