Nguyen Andrea, Shadowen Hannah, Shadowen Caroline, Thakkar Bhushan, Knittel Andrea K, Martin Caitlin E
School of Medicine, Virginia Commonwealth University, Richmond, VA, United States.
Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States.
Front Psychiatry. 2023 Apr 13;14:1157611. doi: 10.3389/fpsyt.2023.1157611. eCollection 2023.
Opioid use disorder (OUD) is a leading cause of pregnancy-associated deaths. OUD treatment with buprenorphine (BUP) reduces overdose risk and improves perinatal outcomes. Incarceration can be a barrier to receipt of OUD treatment during pregnancy and postpartum. The objective of this study was to examine differences in BUP continuation at delivery by patients' incarceration status at the time of BUP initiation.
This is a secondary analysis of a retrospective cohort study of pregnant patients with OUD who delivered at an academic medical center and initiated BUP between January 1, 2018, and March 30, 2020. The primary outcome was BUP continuation at delivery, abstracted from the state prescription monitoring program and electronic medical record, along with incarceration status. Bivariate analysis was used to assess the relationship between BUP continuation and incarceration status.
Our sample included 76 patients, with 62% of patients incarcerated at BUP initiation ( = 47). Among the entire sample, 90.7% ( = 68) received BUP at delivery. Among patients who were incarcerated at BUP initiation, 97% remained on BUP at delivery; among patients who were not incarcerated at BUP initiation, 79% remained on BUP at delivery ( = 0.02).
In our sample from a health system housing a care model for pregnant and parenting people with OUD with local jail outreach, BUP continuation rates at delivery were high, both for patients who were and were not incarcerated at BUP initiation. Findings are intended to inform future work to develop and evaluate evidence-based, patient-centered interventions to expand OUD treatment access for incarcerated communities.
阿片类药物使用障碍（OUD）是妊娠相关死亡的主要原因。使用丁丙诺啡（BUP）治疗OUD可降低过量用药风险并改善围产期结局。监禁可能成为孕期和产后接受OUD治疗的障碍。本研究的目的是探讨在开始使用BUP时处于监禁状态的患者与未处于监禁状态的患者在分娩时BUP持续使用情况的差异。
这是一项对在学术医疗中心分娩且于2018年1月1日至2020年3月30日期间开始使用BUP的患有OUD的孕妇进行的回顾性队列研究的二次分析。主要结局是从州处方监测计划和电子病历中提取的分娩时BUP的持续使用情况以及监禁状态。采用双变量分析来评估BUP持续使用与监禁状态之间的关系。
我们的样本包括76名患者，其中62%（n = 47）的患者在开始使用BUP时处于监禁状态。在整个样本中，90.7%（n = 68）的患者在分娩时接受了BUP治疗。在开始使用BUP时处于监禁状态的患者中，97%在分娩时仍继续使用BUP；在开始使用BUP时未处于监禁状态的患者中，79%在分娩时仍继续使用BUP（P = 0.02）。
在我们这个拥有针对患有OUD的孕妇及育儿者的护理模式且设有当地监狱外展服务的卫生系统样本中，无论在开始使用BUP时是否处于监禁状态，患者在分娩时的BUP持续使用率都很高。研究结果旨在为未来开展和评估基于证据、以患者为中心的干预措施提供信息，以扩大为被监禁人群提供的OUD治疗服务。
