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Treatment of Opioid Use Disorder in Pregnant Women via TelemedicineA Nonrandomized Controlled Trial

Educational Objective
To Understand how opioid use disorder treatment outcomes received via telemedicine compares to treatment received in person in obstetric practices
1 Credit CME
Key Points

Question  Is opioid use disorder treatment received via telemedicine in obstetric practices associated with similar maternal and newborn outcomes compared with opioid use disorder treatment received in person in obstetric practices?

Findings  In this nonrandomized controlled trial including 98 pregnant women with opioid use disorder, there were no statistically significant differences in rates of retention in treatment between women receiving opioid use disorder treatment via telemedicine vs in person (80.4% vs 92.7%). These findings were also apparent in newborns with neonatal abstinence syndrome (telemedicine: 45.4% vs in person: 63.2%).

Meaning  Telemedicine may provide a scalable solution to making lifesaving treatment available to pregnant women to reduce the maternal morbidity and mortality associated with opioid use disorder and improve maternal and child health.

Abstract

Importance  There are high rates of maternal and newborn morbidity and mortality associated with opioid use disorder (OUD). Integrating OUD treatment in obstetric practices for pregnant and postpartum women via telemedicine can increase access to care and reduce the consequences of OUD. Evaluation of this care delivery model, however, is needed before widespread adoption.

Objective  To compare maternal and newborn outcomes among pregnant women with OUD receiving care via telemedicine vs in person.

Design, Setting, and Participants  A nonrandomized controlled trial including 98 women receiving perinatal OUD treatment in 4 outpatient obstetric practices by telemedicine or in person and followed up until 6 to 8 weeks post partum was conducted from September 4, 2017, to December 31, 2018. Logistic regression with propensity score adjustment was applied to reduce group selection bias and control for potentially confounding variables.

Interventions  Participants were seen weekly for 4 weeks, every 2 weeks for 4 weeks, and monthly thereafter and provided relapse prevention therapy and buprenorphine.

Main Outcomes and Measures  The outcomes were retention in treatment, defined as uninterrupted addiction treatment during pregnancy through 6 to 8 weeks post partum; urine drug screen results at delivery and 6 to 8 weeks post partum; and a neonatal abstinence syndrome (NAS) diagnosis collected via electronic health records.

Results  The mean (SD) age of the 98 pregnant women was 30.23 (5.12) years. Of these, 41 of 44 women (93.2%) in the telemedicine group and 48 of 54 women (88.9%) in the in-person group chose to continue treatment in the program after an initial evaluation. After propensity score weighting and doubly robust estimation, no significant differences were found between groups in retention in treatment at 6 to 8 weeks post partum (telemedicine: 80.4% vs in person: 92.7%; treatment effect, −12.2%; 95% CI, −32.3% to −4.4%). Similarly, after propensity score weighting and doubly robust estimation, there were no significant group differences in rates of NAS (telemedicine: 45.4% vs in person: 63.2%; treatment effect, −17.8%; 95% CI, −41.0% to 8.9%).

Conclusions and Relevance  In this nonrandomized controlled trial, virtually integrated OUD care in obstetric practices produced similar maternal and newborn outcomes compared with in-person care. These findings may have important public health implications for combatting the opioid crisis and its consequences on pregnant women and their families. Future large randomized clinical trials are needed.

Clinical Trial Registration  ClinicalTrials.gov identifier: NCT04049032

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Article Information

Accepted for Publication: December 2, 2019.

Published: January 31, 2020. doi:10.1001/jamanetworkopen.2019.20177

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Guille C et al. JAMA Network Open.

Corresponding Author: Constance Guille, MD, MSCR, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425 (guille@musc.edu).

Author Contributions: Drs Guille and Simpson had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Guille, Cristaldi, McElligott, Johnson, Brady.

Acquisition, analysis, or interpretation of data: Guille, Simpson, Douglas, Boyars.

Drafting of the manuscript: Guille, McElligott, Johnson.

Critical revision of the manuscript for important intellectual content: Guille, Simpson, Douglas, Boyars, Cristaldi, Brady.

Statistical analysis: Guille, Simpson.

Obtained funding: Guille, Cristaldi, McElligott, Brady.

Administrative, technical, or material support: Guille, Douglas, Cristaldi, McElligott, Johnson, Brady.

Supervision: Guille, Boyars, Cristaldi, Brady.

Conflict of Interest Disclosures: Dr Guille reported receiving grants from Duke Endowment, grants from the Health Resources and Services Administration, and grants from the National Institute on Drug Abuse during the conduct of the study. Dr Simpson reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Cristaldi reported receiving grants from the Health Resources and Services Administration National Telehealth Center of Excellence outside the submitted work. Dr Brady reported receiving grants from State of South Carolina during the conduct of the study. No other disclosures were reported.

Funding/Support: Funding support for this study was received from the National Institute on Drug Abuse (NIDA) (R34 DA046730), Duke Endowment (6563-SP), and Health Resources and Services Administration as part of the National Telehealth Center of Excellence Award (U66 RH31458).

Role of the Funder/Sponsor: The funding sources did not have a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, the NIDA, Clinical and Translational Science Awards, HRSA, and Department of Health and Human Services.

Additional Contributions: We acknowledge the women and health care clinicians at the obstetric practices taking part in this study. The Board of Medical Examiners, led by Stephen R. Gardner, MD, and Jeffrey Welsh, MD, and Darra Coleman, JD, approved this telemedicine practice request. The practice proposal was endorsed by director Sara Goldsby, MSW, MPH, director of the South Carolina Department of Alcohol and Other Drug Abuse Services.

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