Low-Dose Buprenorphine Induction in Pregnant and Postpartum Patients: A Retrospective Analysis of Protocol...

Low-dose buprenorphine induction (LDBI) is a method using low doses of buprenorphine titrated to maintenance dosing. Literature on LDBI in pregnant and postpartum patients is limited to case series. The purpose of this study was to evaluate the implementation of an LDBI protocol, describe treatment outcomes of pregnant and postpartum patients with OUD who were treated with the protocol, and identify opportunities to improve this protocol.

An interdisciplinary team, including a clinical pharmacist, at a level IV maternity academic medical center developed and implemented an LDBI protocol. We performed a retrospective descriptive chart review of hospitalized pregnant and postpartum patients with opioid use disorder (OUD) at our institution. The primary outcome was successful LDBI, defined as reaching and discharging on goal dose buprenorphine without serious adverse effects. Secondary outcomes included adverse effects, protocol deviations, and characteristics that may predict success. Outpatient follow-up was also described.

Of the 78 patients included for analysis, 59 (75.6%) successfully completed LDBI. Of the 19 (24.4%) patients that did not, 8 (10.3%) left before achieving goal dose without documented reason, 6 (7.6%) had intolerable withdrawal symptoms, and 5 (5.1%) were discharged with plans to attempt LDBI at a later time. Of these 19 patients, 10 (52.6%) had successful LDBI at subsequent encounters with an overall success rate on serial inductions of 69 (88.5%). There were no recorded serious adverse medication events from the protocol that caused patient harm. Tobacco use disorder without nicotine replacement therapy was associated with unsuccessful LDBI. Flexible protocol deviations or modifications may increase LDBI success.

Inpatient LDBI at this level IV maternity care center resulted in high success rates and was well tolerated. Several opportunities for improvement in the implementation of inpatient LDBI were identified. Further research is needed on improving transitions of care to the outpatient setting.