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. 2025 Jan 6;20(1):1.
doi: 10.1186/s13722-024-00530-1.

Buprenorphine and postpartum contraception utilization among people with opioid use disorder: a multi-state analysis

Kevin Y Xu #  1 , Jennifer K Bello #  2 , Joanna Buss  3 , Hendrée E Jones  4 , Laura J Bierut  5 , Dustin Stwalley  3 , Hannah S Szlyk  5 , Caitlin E Martin  6 , Jeannie C Kelly  7 , Ebony B Carter  4 , Elizabeth E Krans #  8 , Richard A Grucza #  2
Affiliations

Buprenorphine and postpartum contraception utilization among people with opioid use disorder: a multi-state analysis

Kevin Y Xu et al. Addict Sci Clin Pract. .

Erratum in

Abstract

Background: The postpartum period provides an opportunity for birthing people with opioid use disorder (OUD) to consider their future reproductive health goals. However, the relationship between the use of medication for opioid use disorder (MOUD) and contraception utilization is not well understood. We used multistate administrative claims data to compare contraception utilization rates among postpartum people with OUD initiating buprenorphine (BUP) versus no medication (psychosocial services receipt without MOUD (PSY)) in the United States (US).

Methods: In this retrospective cohort study, we analyzed data from the Merative™ MarketScan® Multi-State Medicaid Databases 2016-2021 among postpartum women with OUD who did and did not initiate BUP during pregnancy. Our primary outcome was the receipt of prescribed highly-effective or effective contraception by 90 days postpartum. Highly-effective contraception was defined as female sterilization and long-acting reversible contraception [LARC]). Effective contraception was defined as oral contraceptive pills [OCPs], the contraceptive patch, ring, or injection. We used multivariable Poisson regression models, adjusting for sociodemographic and clinical characteristics, to measure the association of BUP (vs. PSY) on postpartum contraception utilization.

Results: Our sample consisted of 11,118 postpartum people with OUD. Among those, 3,443 initiated BUP and 7,675 received PSY. By 90 days postpartum, 22.4% (n = 2,487) of the cohort were prescribed contraception (21.5% PSY vs. 24.3% BUP). Among these participants, most received LARC (41.0%), followed by female sterilization (27.3%), the contraceptive injection (17.3%), pills (8.6%), ring (4.7%), and patch (1.0%), Compared to people engaged in PSY, BUP receipt was associated with a greater use of prescribed contraceptive use by 90 days postpartum (adjusted relative risk [aRR] = 1.17[1.07-1.28]), including a modestly greater use of the patch, ring, and pills, (aRR = 1.13[1.08-1.18]), but a modestly lesser use of injection contraception (aRR = 0.95[0.91-0.99]). There was no relationship observed between BUP and LARC use (aRR = 1.00[0.95-1.04]) and female sterilization (aRR = 1.01[0.98-1.06]).

Conclusions: Only 22% of pregnant people with OUD in our cohort used effective or highly-effective postpartum contraception. BUP receipt during pregnancy, relative to PSY, was associated with modestly greater use of prescribed effective contraceptive methods but was not associated with greater use of provider-administered contraceptive methods, such as the contraceptive injection, LARC and female sterilization.

Keywords: Administrative data; Buprenorphine; Contraception; LARC; Opioid use disorder.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Dissemination declaration: Dissemination to study participants and or patient organizations is not possible or applicable due to the de-identified nature of our data. Presentations: Oral Presentation, AMERSA Annual Meeting, November 4 2023, Washington DC, USA Competing interests: Dr Grucza reported receiving grants from the NIH and Arnold Ventures LLC during the conduct of the study, consulting for Janssen Pharmaceuticals, and receiving personal fees for grant reviews from the NIH outside the submitted work. Dr. Krans is an investigator on grants to Magee-Women’s Research Institute from the National Institutes of Health, Gilead, and Merck outside of the submitted work. These funding sources did not influence the design of the present study and the interpretation of data. The authors alone are responsible for the content and writing of this paper.

Figures

Fig. 1
Fig. 1
Derivation of the analytic sample
See this image and copyright information in PMC

References

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