Original Article

High Prevalence of Buprenorphine in Prenatal Drug Screens in an Appalachian City

Authors: Charlotte Alexander, MD, Kevin Breuel, PhD, Martin Olsen, MD

Abstract

Objectives: To define the magnitude of buprenorphine presence in the urine drug screens of pregnant women and to assess the presence of illicit buprenorphine use versus the presence of prescribed buprenorphine use.

Methods: Initial prenatal drug screen results for all pregnant patients in our practice for a 1-year period were analyzed and tabulated.

Results: Buprenorphine was found in the urine drug screens of 16% of pregnant patients. The presence of buprenorphine was by far the highest for any substance associated with neonatal abstinence syndrome (NAS). We estimate that the exposure to buprenorphine of approximately one-third of individuals in our population is associated with illicit buprenorphine use.

Conclusions: The high rate of NAS in our region is primarily associated with both illicit and prescribed buprenorphine rather than other substances. Buprenorphine usage at the time that prenatal care is initiated, rather than opiate use at the onset of prenatal care, is the underlying factor that must be addressed if our region is to successfully combat our high rates of NAS.
Posted in: Obstetrics and Gynecology77 Pregnancy32

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References

1. Erwin PC, Meschke LL, Ehrich SF, et al. Neonatal abstinence syndrome in East Tennessee: characteristics and risk factors among mothers and infants in one area of Appalachia. J Health Care Poor Underserved 2017;28:1393-1408.
2. Ko JY, Partick SW, Tong VT, et al. Incidence of neonatal abstinence syndrome-28 states, 1999-2013. MMWR Morb Mortal Wkly Rep 2016;65:799-802.
3. Division of Health Care Finance and Administration. Neonatal abstinence syndrome among TennCare enrollees-2015 data. https://www.tn.gov/content/dam/tn/tenncare/documents/TennCareNASData2015.pdf. Updated May 9, 2017. Accessed April 17, 2019.
4. Tennessee Department of Health, Division of Family Health and Wellness. Neonatal abstinence syndrome surveillance Annual report 2017. https://www.tn.gov/content/dam/tn/health/documents/nas/NAS%20Annual%20Report%202017%20FINAL.pdf. Accessed April 17, 2019.
5. Olsen M, Walker JJ. Provision of buprenorphine to pregnant women by for-profit clinics in an Appalachian city. South Med J 2018;111:575-578.
6. Committee on Obstetric Practice. Committee opinion no. 711: opioid use and opioid use disorder in pregnancy. Obstet Gynecol 2017;130:e81-e94.
7. Substance Abuse and Mental Health Services Administration. Medication and counseling treatment. https://www.samhsa.gov/medication-assisted-treatment/treatment. Published 2017. Accessed March 17, 2019.
8. Weigand SL, Stringer EM, Stuebe AM, et al. Buprenorphine and naloxone compared with methadone treatment in pregnancy. Obstet Gynecol 2015;125:363-368.
9. Jones HE, Heil SH, Baewert A, et al. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction 2012;107( suppl 1 ):5-27.
10. Kermack A, Flannery M, Tofighi B, et al. Buprenorphine prescribing practice trends and attitudes among New York providers. J Subst Abuse Treat 2017;74:1-6.
11. Meyer M, Phillips J. Caring for pregnant opioid abusers in Vermont: a potential model for non-urban areas. Prev Med 2015;80:18-22.
12. Molfenter T, Sherbeck C, Zehner M, et al. Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. Subst Abuse Treat Prev Policy 2015;10:13.
13. Allen B, Harocopos A. Non-prescribed buprenorphine in New York City: motivations for use, practices of diversion, and experiences of stigma. J Subst Abuse Treat 2016;70:81-86.
14. Rizzo RA, Neumann AM, King SOC, et al. Parenting and concerns of pregnant women in buprenorphine treatment. MCN Am J Matern Child Nurs 2014;39:319-324.
15. Bell J, Towers CV, Hennessy MD, et al. Detoxification from opiate drugs during pregnancy. Am J Obstet Gynecol 2016;215:374.e1-e6.
16. Stewart RD, Nelson DB, Adhikari EH, et al. The obstetrical and neonatal impact of maternal opioid detoxification in pregnancy. Am J Obstet Gynecol 2013;209:267.e1-e5.
17. Klaman SL, Isaacs K, Leopold A, et al. Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: literature review to support national guidance. J Addict Med 2017;11:178-190.
18. Winkelman TNA, Villapiano N, Kozhimannil KB, et al. Incidence and costs of neonatal abstinence syndrome among infants with Medicaid: 2004-2014. Pediatrics 2018;141:e20173520.
19. Corr TE, Hollenbeak CS. The economic burden of neonatal abstinence syndrome in the United States. Addiction 2017;112:1590-1599.
20. van Barr A, de Graaff BM. Cognitive development at preschool-age of infants of drug-dependent mothers. Dev Med Child Neurol 1994;36:1063-1075.
21. Sundelin Wahlsten V, Sarman I. Neurobehavioural development of preschool-age children born to addicted mothers given opiate maintenance treatment with buprenorphine during pregnancy. Acta Paediatr 2013;102:544-549.
22. Fill MA, Miller AM, Wilkinson RH, et al. Educational disabilities among children born with neonatal abstinence syndrome. Pediatrics 2018;142:e20180562.