TY - JOUR
KW - Buprenorphine/therapeutic use
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - medication assisted treatment
KW - Methadone
KW - Methadone/therapeutic use
KW - Narcotic Antagonists/therapeutic use
KW - Narcotics/therapeutic use
KW - Opiate Substitution Treatment
KW - opioid use disorder
KW - Opioid-Related Disorders/drug therapy
KW - Patient dropout
KW - Patient Dropouts/statistics & numerical data
KW - Postpartum
KW - Postpartum Period
KW - Pregnancy
KW - Pregnancy Complications/drug therapy
KW - Pregnancy Outcome
KW - Retrospective Studies
AU - C. Wilder
AU - D. Lewis
AU - T. Winhusen
A1 - 
AB - BACKGROUND: Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder. METHODS: We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006-2013) of pregnant and postpartum women in a university affiliated methadone clinic. RESULTS: We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR = 0.98, 95% CI (0.96, 0.99)). CONCLUSIONS: We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder.
BT - Drug and alcohol dependence
C5 - Opioids & Substance Use
CY - Ireland
DO - 10.1016/j.drugalcdep.2015.02.012
JF - Drug and alcohol dependence
N2 - BACKGROUND: Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder. METHODS: We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006-2013) of pregnant and postpartum women in a university affiliated methadone clinic. RESULTS: We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR = 0.98, 95% CI (0.96, 0.99)). CONCLUSIONS: We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder.
PP - Ireland
PY - 2015
SN - 1879-0046; 0376-8716
SP - 225
EP - 231
EP - 
T1 - Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder
T2 - Drug and alcohol dependence
TI - Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder
U1 - Opioids & Substance Use
U2 - 25735465
U3 - 10.1016/j.drugalcdep.2015.02.012
VL - 149
VO - 1879-0046; 0376-8716
Y1 - 2015
ER -