Telehealth effective for opioid use disorder care in pregnancy

Key takeaways:

• Most participants continued opioid use disorder care via telehealth through 6 weeks postpartum with high treatment adherence.
• More than 80% of women using telehealth care carried a pregnancy to term.

Telehealth may be a useful modality in providing care for opioid use disorder to pregnant women with similar obstetric outcomes as that of in-person care, researchers reported in JAMA Network Open.

“Although treatment with buprenorphine during pregnancy is safe, effective and reduces maternal mortality, pregnant people face barriers to treatment,” M. Justin Coffey, MD, chief medical officer at Workit Health and professor of psychiatry at Geisinger Commonwealth School of Medicine, Pennsylvania, and colleagues wrote. “Telehealth has emerged as a promising modality for delivering and increasing access to opioid use disorder care, yet outcomes for pregnancy populations within dedicated telehealth settings have not been reported.”

Coffey and colleagues conducted a cohort study with data from 94 pregnant women (mean age, 32.3 years) with opioid use disorder who previously received buprenorphine or buprenorphine and naloxone treatment from 2018 to 2022. All women received opioid use disorder care through a U.S. low-barrier, multistate telemedicine addiction treatment program.

Primary outcome was continuous care for opioid use disorder throughout pregnancy. Secondary outcomes included continued telehealth treatment, care retention through 6 weeks postpartum, treatment adherence via urine drug screen confirmation and obstetric outcomes.

Overall, 78.7% of participants were on Medicaid and 22.3% lived in rural areas. In addition, 42.6% of women were pregnant at their initial telehealth opioid use disorder appointment.

Most women (79.8%) received continuous telehealth opioid use disorder care throughout pregnancy. Of those who did not receive continuous telehealth care throughout pregnancy, 13.8% were lost to follow-up and 6.4% were discharged due to administrative or financial reasons.

Eight percent of pregnant women with continuous opioid use disorder telehealth care transferred care to prenatal clinicians. Of those who did not transfer, 94.2% continued telehealth care through 6 weeks postpartum, and 100% tested positive for buprenorphine in postpartum urinary drug screens.

Women who became pregnant once established in opioid use disorder telehealth care were more likely to continue care throughout pregnancy compared with women who were pregnant at treatment initiation, according to the researchers. Researchers observed no differences in continuous care based on buprenorphine formulation, comorbid substance use, comorbid mental health conditions or insurance status.

Regarding obstetric outcomes, 82.6% carried a pregnancy to term, 13% had spontaneous termination and 4.3% had medical termination.

According to the researchers, these obstetric outcomes are similar to results from opioid use disorder care delivered in an in-person obstetric practice.

“Our findings add to the emerging evidence supporting the effectiveness of telehealth-based opioid use disorder treatment in this vulnerable population,” the researchers wrote.