Predictive Factors Associated with Naloxone Prescription among Pregnant People Admitted for the Management of Opioid Use Disorder

OBJECTIVE

 Our objective was to examine the biomedical and sociodemographic factors associated with the prescription of naloxone among pregnant people with opioid-use disorder (OUD) who were admitted for initiation of medications for OUD (i.e., buprenorphine-containing medications or methadone) following the implementation of a statewide initiative focused on reducing adverse perinatal health outcomes.

STUDY DESIGN

 This is a single-site, retrospective cohort study of pregnant people admitted for the management of OUD at an urban, tertiary care center between 2013 and 2020. The primary outcome is evidence of a prescription of naloxone, ascertained from the electronic medical record. Bivariate and multivariable logistic regression modeling was performed to evaluate biomedical and sociodemographic variables associated with a prescription for naloxone. Covariates for inclusion in the multivariate logistic regression model were selected based on a p < 0.05 on bivariate analysis. Statistical significance was set at p < 0.05.

RESULTS

 One hundred and thirty-nine participants met the inclusion criteria. On bivariate analysis, people who received naloxone were more likely to be admitted after the initiation of a statewide initiative focused on reducing adverse perinatal outcomes associated with perinatal OUD. Those individuals reporting intravenous drug use (IVDU) were less likely to receive naloxone. On multivariate logistic regression, after controlling for IVDU and epoch of admission, both IVDU (adjusted odds ratio [aOR]: 0.27, 95% confidence interval [CI]: 0.11-0.70) and epoch of admission (aOR: 3.48, 95% CI: 1.28-9.50) were independently associated with receipt of prescription of take-home naloxone.

CONCLUSION

 Naloxone prescription was independently associated with the epoch of admission and route of drug administration. These data can be useful in the evaluation and development of clinical practices to increase rates of naloxone prescription in pregnant people with OUD admitted for inpatient management.

KEY POINTS

· Thirty four percent of individuals with perinatal OUD were prescribed take-home naloxone (THN).. · Epoch of admission and route of drug administration were independently associated with THN.. · These data can be used to guide public health and clinical programming for pregnant people..

Predictors of Preexposure Prophylaxis Eligibility among Pregnant People with Opioid Use Disorder

OBJECTIVE

 We seek to evaluate risk factors for eligibility for preexposure prophylaxis (PrEP) among pregnant people with opioid use disorder (OUD).

STUDY DESIGN

This is a single-site retrospective cohort study of pregnant people admitted for management of OUD at an urban, tertiary care center from 2013 to 2022. PrEP eligibility was defined based on (1) modified American College of Obstetricians and Gynecologists' (ACOG) 2014 criteria: diagnosis of a sexually transmitted infection (STI), engagement in transactional sex work, intravenous drug use (IVDU), or incarceration and (2) modified 2021 Centers for Disease Control (CDC) criteria: diagnosis of bacterial STI (e.g., gonorrhea or syphilis) or transactional sex work. Risk factors associated with PrEP eligibility were evaluated using chi- square or Fischer's exact tests for categorical variables and t-tests or Wilcoxon rank-sum tests for continuous variables. Multivariable regression was used to control for confounding covariates, defined as p < 0.10 on bivariate analysis. p < 0.05 was used to indicate statistical significance.

RESULTS

 A total of 132 individuals met inclusion criteria, of whom 101 (76.5%) were deemed eligible for PrEP by meeting one or more modified 2014 ACOG criteria: 42 (31.8%) were incarcerated or had one or more STIs, while 30 (22.7%) endorsed engaging in transactional sex work and 68 (58.6%) endorsed IVDU. Using modified 2021 CDC criteria, 37 (28%) met PrEP eligibility, with 12 (9.1%) diagnosed specifically with a bacterial STI and 30 (22.7%) engaging in transactional sex work. Only comorbid psychiatric illness was associated with an increased risk for PrEP eligibility based on 2014 criteria, which persisted after controlling for maternal race/ethnicity (aRR 1.52, 95% confidence interval [CI] 1.24-1.86), and 2021 criteria, which persisted after controlling for nulliparity (aRR 2.12, 95% CI 1.30-3.57).

CONCLUSION

 A significant number of pregnant people with OUD meet one or more criteria for PrEP, with comorbid psychiatric conditions increasing the risk of meeting criteria.

KEY POINTS

· Comorbid psychiatric illness is significantly associated with high risk of PrEP eligibility.. · A large proportion of pregnant individuals with active OUD meet criteria for PrEP prescribing.. · Risk-based screening algorithms for PrEP eligibility have limitations..

Does self-reported consumption of heroin correlate with dose of methadone among pregnant people with opioid use disorder?

BACKGROUND

The prevalence of opioid use disorder (OUD) during pregnancy is increasing in the United States. However, evidence to guide appropriate dosing of pharmacotherapy for treatment of OUD, such as methadone, based on self-reported opioid use during pregnancy is scant.

OBJECTIVE

To examine the relationship between self-reported consumption of heroin and methadone dose among pregnant people with opioid use disorder (OUD) admitted to the hospital for methadone (MTD) titration.

STUDY DESIGN

This is an analysis of a single-site retrospective cohort of pregnant people admitted for management of OUD at an urban, tertiary care center between 2013 and 2020. Patient-reported consumption of heroin was evaluated by clinical staff and described as self-reported dollar amount of heroin consumed per day. The primary outcome was MTD dose at the time of discharge. The secondary outcome was MTD dose at time of delivery. Bivariate and linear regression modeling were performed. A priori covariates included in the model were: epoch of admission, Clinical Opioid Withdrawal Scale score at time of admission, gestational age at admission, and need for readmission due to recurrent opioid use. A sensitivity analysis was performed using propensity score matching. Statistical significance was set at p < 0.05.

RESULTS

Of 100 people admitted during the study period, 53 and 47 individuals met inclusion criteria for the primary and secondary outcome, respectively. On bivariate and multivariate linear regression modeling, self-reported dollar amount of heroin consumed per day was independently associated with dose of MTD at the time of discharge. For every ten dollars of heroin consumed, the dose of MTD increased by 1.3 mg (95% CI: 0.4 mg to 2.2 mg). On sensitivity analysis with use of a propensity score, self-reported dollar amount of heroin consumed per day was independently associated with dose of MTD at the time of discharge. There was no significant relationship between self-reported dollar amount of heroin consumed per day and MTD dose at time of delivery.

CONCLUSIONS

Self-reported dollar amount of heroin consumed per day was independently associated with dose of MTD at the time of discharge, but not at time of delivery. These data can be useful in clinical counseling and management of pregnant people with OUD admitted for initiation of MTD.