Management of Opioid Use Disorder Among Peripartum Individuals During Hospitalization

Objectives: Peripartum opioid use disorder (OUD) is a significant public health concern. Although hospital admission for labor and delivery is common, little is known about hospitalized peripartum individuals with OUD or their inpatient management. The purpose of this study was to characterize hospitalized peripartum individuals with OUD who were seen by an OUD consult service and to examine their inpatient OUD treatment. Methods: This was a retrospective cohort study of peripartum individuals who received an OUD consult from May 2020 to April 2022. All individuals were pregnant or up to 3 months postpartum at admission. Substance use and psychosocial history were collected, along with timing and acceptance of medication for opioid use disorder (MOUD) and details of discharge transitions. Results: Of the 23 peripartum individuals with OUD who received a consult during admission, 61% were white, 30% were black, and all were non-Hispanic. Most individuals (78%) had Medicaid. Only 30% were using MOUD at hospital admission. Two-thirds (63%) of those not using MOUD were started on treatment during hospitalization, most commonly with buprenorphine-naloxone. At discharge, most (74%) individuals were connected to outpatient OUD treatment. Of the total, 35% self-directed their discharge, and there was a higher proportion of self-directed discharges among those who did not receive inpatient MOUD compared with those who did (P < 0.01). Conclusions: Hospitalization during the peripartum period is an important opportunity for initiation of MOUD and linkage to longitudinal, community OUD services. Further understanding of factors contributing to high rates of self-directed discharge in the peripartum period is needed.

Duke Scholars

Author Rebecca Lumsden Medicine, Hospital Medicine

Author Dana Cooley Clifton Medicine, Hospital Medicine