A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy

Rose A Schmidt; Karl Everett; Amaya Perez-Brumer; Carol Strike; Brian Rush; Tara Gomes

doi:10.1111/add.16459

A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy

Addiction. 2024 Mar 13. doi: 10.1111/add.16459. Online ahead of print.

Authors

Rose A Schmidt^{1

2

3}, Karl Everett³, Amaya Perez-Brumer¹, Carol Strike¹, Brian Rush², Tara Gomes^{3

4

5

6}

Affiliations

¹ Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
² Centre for Addiction and Mental Health (CAMH), Institute for Mental Health Policy Research, Toronto, Canada.
³ ICES, Toronto, Canada.
⁴ Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, Canada.
⁵ Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
⁶ Management and Evaluation at the University of Toronto, Institute of Health Policy, Toronto, Ontario, Canada.

PMID: 38476027
DOI: 10.1111/add.16459

Abstract

Background and aims: Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada.

Design: This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed.

Setting and participants: The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period.

Measurements: We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario.

Findings: Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015).

Conclusion: Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.

Keywords: Buprenorphine; ecological study; medications for opioid use disorder; methadone; opioid agonist treatment; opioids; pregnancy; time-series analysis.

Abstract

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