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.
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.
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.
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.
Alane O’Connor, DNP is the director of perinatal addiction medicine at Maine Medical Center and is the medical advisor 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 individuals in Maine. She also co-chairs Maine’s Opioid Response Clinical Advisory Committee, which advises the Governor’s opioid response director on clinical and public policy issues. Dr. O’Connor has more than 15 years of experience in addiction medicine in a variety of settings including the design and implementation of an extended-release buprenorphine pilot at Somerset County Jail, rapid access to substance use treatment in emergency departments through Maine Medical Association’s Project RISE, as well extensive experience caring for pregnant patients with substance use disorder in both the inpatient and outpatient settings. She lectures regionally and nationally and has trained more than 100 family medicine and obstetric resident physicians. She is a core faculty member of Maine’s only addiction medicine fellowship program. Finally, she has published numerous peer reviewed articles on maternal and infant outcomes of substance exposed pregnancies including the related child welfare implications as well as the care of incarcerated pregnant patients.