Extended-Release Buprenorphine During Pregnancy and Postpartum
The use of extended-release buprenorphine (XRB) is becoming increasingly common in patients with opioid use disorder. There is an ongoing clinical trial examining the safety, efficacy, and pharmacokinetics of XRB in pregnant and postpartum women. We will review the potential use of XRB in pregnant and postpartum patients while awaiting the results from this trial and describe ways in which clinicians can engage in shared decision-making with their patients around whether XRB may be appropriate.
Objectives
1) Describe the basic logistics of acquiring extended-release buprenorphine (XRB) including REMS certification and the MaineCare coverage criteria.
2) Identify pregnant and postpartum patients who may be appropriate for XRB and demonstrate an approach to discussing the potential risks and benefits of its use during the perinatal period.
3) Explain XRB issues that are unique to the perinatal population including medication administration and appropriate monitoring for neonatal opioid withdrawal syndrome.
Audience
Prescribing clinicians and their teams
Continuing Medical Education
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Maine Medical Education Trust and CCSME. The Maine Medical Education Trust is accredited by the Maine Medical Association Committee on Continuing Medical Education and Accreditation to provide continuing medical education for physicians.
The Maine Medical Education Trust designates this regularly scheduled series for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Contact Hours
1 contact hour for social workers, licensed clinical professional counselors, and behavioral health professionals.
1 contact hour for drug and alcohol counselors pending approval from the Maine Board of Drug and Alcohol Counselors.
1 Category I contact hour for Maine psychologists. CCSME is a pre-approved sponsor and provider of Maine Professional Education Activities for Psychologists.
Speaker
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Alane O'Connor DNPDr. Alane O’Connor DNP is the Director of Perinatal Addiction Medicine at MaineHealth Maine Medical Center and served as the medical director of the Maine Maternal Opioid Misuse (MaineMOM) Initiative, a 5-year, $5 million federal grant to expand access to substance use treatment for pregnant and postpartum women. She has trained hundreds of resident physicians and fellows and is core faculty in Maine’s only addiction medicine fellowship. Dr. O’Connor has published more than a dozen peer-reviewed manuscripts on maternal and infant outcomes following treatment with medication for opioid use disorder during pregnancy as well as related postpartum healthcare utilization and health policy. , She developed a partnership with Portland Fire Department’s Mobile Medical Outreach (MMO) team after recognizing that some of her most at-risk pregnant women were not accessing health care in traditional settings. Project Lifeline is a nationally innovative medical and community paramedicine program that delivers street medicine services to unhoused pregnant and postpartum women with substance use disorder who live in tents, shelters, vehicles, and on the street.
Beyond caring for pregnant women, Dr. O’Connor works in the correctional system as the Director of Addiction Medicine at Somerset County Jail and Franklin County Detention Center and is the clinical advisor to the Maine Sheriffs’ Association. In this capacity, she developed and implemented a nationally innovative program using a monthly injectable medication (rather than a daily pill) to treat incarcerate individuals with opioid use disorder. The outcomes, published in Health & Justice, showed that the injectable medication expanded access to treatment during incarceration, improved treatment continuation after release and reduced the risk of post-release drug overdose death. The project gained nationwide attention and was featured on the front page of the New York Times and a related podcast.
Dr. O’Connor lectures regionally and nationally on substance use disorder to a variety of audiences including medical providers, the child welfare system, the correctional system and judiciary, as well as law enforcement. She is a member of the Maine Maternal Fetal and Infant Mortality Review Panel and co-chairs Maine’s Opioid Response Clinical Advisory Committee which advises the state’s opioid response director on clinical and public policy issues.Director of Addiction Medicine Somerset County Jail
– Director of Addiction Medicine Franclin County Detention Center
– Director, MaineHealth Maine Medical Center Perinatal Addiction Medicine
– Director, MaineHealth Maine Medical Center Correctional Addiction Medicine
– Assistant Clinical Professor, Tufts University School of Medicine
– MaineHealth Comprehensive Addiction Medicine