(82) Mothers’ Knowledge, Attitudes, and Perception Regarding Extended-Release Buprenorphine

Introduction: In the past two decades, the prevalence of opioid use disorder (OUD) among pregnant and postpartum individuals has quadrupled in the United States. Recent studies have suggested that extended-release buprenorphine (XR-BUP) may be an attractive option for pregnant and postpartum individuals with OUD. However, little is known about this population’s awareness and understanding of this medication for opioid use disorder (MOUD). The purpose of this study was to explore pregnant and postpartum individuals’ knowledge, attitudes, and perception regarding XR-BUP injection.

Methods: An anonymous paper-based survey was distributed to individuals with OUD attending a multi-disciplinary prenatal and postpartum specialty care clinic where XR-BUP is available. Participants’ non-identifiable demographic and treatment characteristics, including duration and satisfaction of current MOUD, were collected. Participants’ knowledge, attitudes, and perceptions about XR-BUP were assessed using a 5-point Likert scale. Descriptive statistics were used to summarize the data.

Results: From February 2021–August 2021, a total of 79 respondents completed the survey, representing a response rate of 81% (79/98). The majority were 26-35 years old (87%), identified as Caucasian (84%), and had a high school degree or more (76%). Most (58%) were pregnant (10% first trimester, 31% second trimester, and 17% third trimester), and 42% were within one year of postpartum. More than nine out of ten respondents were currently taking MOUD: sublingual buprenorphine/naloxone (49%), methadone (28%), sublingual buprenorphine (6%), XR-BUP (9%), naltrexone injection (2%), or none (6.3%). Nearly half (53.2%) took their current OUD medication for six months or more, and practically two-thirds (64%) were either satisfied or very satisfied with the current MOUD.

Almost half (49%) had never heard of XR-BUP, followed by 36% who heard about it from a health care provider and 24% from friends or family. Most (85%) did not personally know anyone taking XR-BUP. However, 46% were interested in starting an injectable medication for OUD to avoid trouble remembering to take daily medication, 44% were comfortable coming to the clinic for a monthly injection during the Covid-19 pandemic, and 29% were interested in XR-BUP to avoid daily withdrawal symptoms. One in eight respondents reported that pain from an injection site would discourage them from taking XR-BUP.

Conclusions: In a population of pregnant and postpartum individuals, nearly half were unaware of a monthly XR-BUP option for MOUD, but a sizeable proportion was interested in considering this medication. While XR-BUP is not currently recommended for pregnant individuals, future studies are needed to explore this option for postpartum individuals.

References:
1. Haight, S. C., Ko, J. Y., Tong, V. T., Bohm, M. K., & Callaghan, W. M. (2018). Opioid use disorder documented at delivery hospitalization—United States, 1999–2014. Morbidity and Mortality Weekly Report, 67(31), 845.
2. Cleary, E. M., Byron, R. K., Hinely, K. A., Talley, A. W., Costantine, M. M., & Rood, K. M. (2020). Subcutaneous buprenorphine extended-release use among pregnant and postpartum women. Obstetrics & Gynecology, 136(5), 902-903.
3. Shadowen, C., Moeller, F. G., & Martin, C. E. (2021). The use of once-monthly injectable buprenorphine for the treatment of opioid use disorder in postpartum women: A case series. Journal of Addiction Medicine, 15(4), 292-296.
4. Bernstein, S. N., Peckham, A. M., Schiff, D. M., & Gray, J. R. (2021). Subcutaneous Buprenorphine Extended-Release Use Among Pregnant and Postpartum Women. Obstetrics & Gynecology, 137(2), 377-378.

Diversity, Equity, and Inclusion: To better understand the context of diversity, health equity, and addressing healthcare disparities, it is important to recognize the impact and variation of demographics, including all pregnant and postpartum individuals from different socioeconomic backgrounds and health outcomes. In our efforts to address these themes from our study, we primarily assess their attitudes, knowledge, and perception of their current treatment for opioid use disorder and identify if there are any concerns regarding extended-release buprenorphine. We also added other types of outcomes related to demographic factors, including race, ethnicity, gender, and level of education, to eliminate the disparity.