Psychiatric comorbidities and their treatment predict buprenorphine continuation among postpartum people with opioid use disorder

Abstract

Background: Opioid use disorder (OUD) is a growing crisis among pregnant and postpartum people. Psychiatric comorbidities are common, yet how they impact OUD treatment outcomes is not well characterized. The aim of this study was to assess the association of psychiatric comorbidities and receipt of psychiatric treatment with buprenorphine continuation through one year postpartum among a sample of people with OUD.

Methods: A subsample was identified from a larger retrospective cohort of patients receiving buprenorphine for OUD at the time of delivery from an academic medical center between 2017 and 2020. Medical record abstractions were conducted during pregnancy through one year postpartum. Independent variables included any psychiatric diagnosis and postpartum receipt of psychiatric treatment (medication or behavioral health). The primary outcome was week of buprenorphine discontinuation. Cox Proportional Hazard models were used.

Results: Of 138 patients, 71.8% had a psychiatric condition and 35.5% continued buprenorphine for a full year postpartum. Postpartum buprenorphine continuation was associated with (a) Psychiatric co-morbidity (buprenorphine discontinuation HR 0.49; 95% CI 0.29, 0.82), (b) Receipt of psychiatric medications in weeks 39-52 postpartum (buprenorphine discontinuation HR 0.21; 95% CI 0.06, 0.83), and (c) Receipt of behavioral health therapy in weeks 9-38 postpartum (buprenorphine discontinuation HR 0.40; 95% CI 0.18, 0.90).

Conclusion: Our work suggests a dynamic relationship between OUD treatment outcomes, psychiatric comorbidities and receipt of psychiatric treatments through the highly vulnerable postpartum period. Clinicians and researchers alike should work to advance patient-centered engagement in integrated care models tailored for this unique population.

Keywords: Mental illness; Opioid use disorder; Perinatal; Postpartum.

Fig. 1

Study Schema and final sample size.

Fig. 2

Kaplan-Meier Survival Curves of time to buprenorphine discontinuation through 52 weeks postpartum among the total sample and the subsample of patients with a psychiatric diagnosis. Graphs illustrate buprenorphine continuation trajectories through the 52 week postpartum period for the (A) total sample, (B) total sample by presence of any psychiatric diagnosis, (C) the sub-sample with a psychiatric diagnosis by receipt of postpartum psychiatric medication, (D) the sub-sample with a psychiatric diagnosis by receipt of postpartum behavioral health therapy. For A-D, x axis represents time from delivery to discontinuation of buprenorphine (weeks) or until censored at 52 weeks. For A-D, y-axis represents the number of individuals remaining on buprenorphine at that week over the number of individuals at risk of discontinuing buprenorphine.