Postpartum Buprenorphine: A Descriptive Analysis of Dose Adjustments and Treatment Retention

Buprenorphine is a partial opioid agonist used in the treatment of opioid use disorder. Dosing of buprenorphine is determined clinically, with peripartum adjustments often indicated due to physiological and psychosocial changes in pregnancy and the postpartum period. We sought to describe these postpartum dose changes, how adjustments varied across demographics, and their association with treatment retention.

This is a retrospective, descriptive analysis of antenatal buprenorphine initiations at one academic institution over 2 years. The primary outcome of interest was the difference in buprenorphine dose at 3 months postpartum compared with the delivery dose.

Sixty-six individuals were included in this study. The majority (36/66; 55%) had no change in buprenorphine dose between delivery and 3 months postpartum. One-third of patients had their dose increased postpartum, with a minority of individuals (8/66; 12%) reducing their dose postpartum. Individuals who were incarcerated at the time of delivery were more likely to experience a dose reduction (P = 0.045). There was no significant difference in treatment retention at 1 year postpartum between the groups.

Our data suggest heterogeneity in the management of buprenorphine dosing in the postpartum period. The vast majority (58/66; 88%) of patients either increased or maintained their total daily dose between delivery and 3 months postpartum. These results underscore the importance of an individualized approach to postpartum buprenorphine, factoring in delivery dose, biopsychosocial factors, and risk of return to use and overdose. Future qualitative work is needed to explore the dynamic patient and provider priorities at play in this decision-making.