(426) Patient satisfaction with buprenorphine or methadone for treatment of opioid use disorder during obstetric care

Thursday, February 9, 2023

4:00 PM – 5:30 PM

Objective: While both are used to treat opioid use disorder (OUD), methadone and buprenorphine have distinct attributes that may impact patient experience. We sought to understand patient satisfaction in an OUD-specific prenatal clinic which supports home induction/titration of buprenorphine and use of outside-prescribed methadone.

Study Design: Pregnant patients with OUD completed prenatal and postpartum surveys regarding satisfaction with their prescribed treatment. Surveys contained Likert scale questions. Demographic data were obtained from records. Patient satisfaction was compared between the pre-and postpartum groups, and stratified by prescribed medication. Responses were compared using Fisher’s exact tests.

Results: 33 patients were included, with 28 completing prenatal, 15 completing postpartum, and 10 completing both surveys. Buprenorphine use was more common in both the prenatal and postpartum groups (75%, 73%). Most patients rated buprenorphine as a “generally satisfactory” or “excellent” medication that makes it possible to solve their opioid addiction (81% prenatal, 91% postpartum), with a minority rating it as “mixed”, “generally unsatisfactory”, or “terrible” (Figure 1). While most prenatal patients rated methadone positively for solving opioid addiction (86%), only half of postpartum patients felt similarly (50%) (Figure 2). Most buprenorphine patients (86% prenatal, 91% postpartum) and 71% of prenatal methadone patients rated dose titration positively, versus 50% of postpartum methadone patients. Postpartum methadone patients were significantly less likely to report a positive impression of side effects than postpartum buprenorphine patients (25% vs 100%, p=0.01).

Conclusion: While both medications were viewed positively, postpartum methadone patients trended towards decreased satisfaction relative to those on buprenorphine, with a significantly worse impression of side effects. Given barriers to methadone adherence, the busy postpartum period may be a vulnerable time for unsatisfied patients, and further study is needed to clarify patient concerns.

Primary & Presenting Author(s)

Cassandra Trammel, MBA, MD (she/her/hers)
Fellow
Washington University in St.Louis
St. Louis, Missouri, United States

Coauthor(s)

Megan L. Lawlor, MD
Saint Louis University School of Medicine
St. Louis, Missouri, United States
HJ
Heather Jacobsen, MPH
Washington University in St.Louis
St. Louis, Missouri, United States
MM
Melissa Mills, N/A
Washington University in St.Louis
St. Louis, Missouri, United States
MK
Melissa Krauss, MPH
Evaluation Center, Brown School at Washington University in St. Louis
St. Louis, Missouri, United States
BG
Bridget Galati, DO
Washington University in St.Louis
St. Louis, Missouri, United States
Nandini Raghuraman, MD,MSc (she/her/hers)
Assistant Professor
Barnes Jewish Hospital, Washington University in St Louis
St. Louis, Missouri, United States
Ebony B. Carter, MD, MPH (she/her/hers)
Associate Professor, MFM; Chief, Division of Clinical Resarch
Washington University School of Medicine
St. Louis, Missouri, United States
Anthony O. Odibo, MD
Professor
Washington University School of Medicine
St. Louis, Missouri, United States
JK
Jeannie C. Kelly, MD,FACOG,MS
Associate Professor
Washington University School of Medicine
St. Louis, Missouri, United States