(699) Inpatient versus outpatient/home initiation of medications for opioid use disorder (MOUD) in pregnancy

This was an IRB-approved retrospective chart review conducted at a single academic center. We included patients with a diagnosis of opioid use disorder, who initiated MOUD in pregnancy, and received care in our comprehensive substance use in pregnancy clinic.

Results: A total of 163 patients were identified as being treated with MOUD, 45 of whom initiated or re-initiated in pregnancy.  Of the 45, 28 patients were initiated MOUD inpatient and 17 outpatient. There was no difference between groups for maternal age, self-reported race, ethnicity, parity and gestational age at delivery.  Patients in the inpatient group were more likely to use methadone (inpatient 75%, outpatient 35%, p=0.008) and the average gestational age at initiation of MOUD between groups was different (inpatient 24.9, outpatient 18.5 weeks, p=0.023). There was no significant difference in the rate of self-reported substance use between group (inpatient 36%, outpatient 59%, p=0.216). The rate of urine toxicology diagnosed non-prescribed substance use was no different between groups (inpatient 64%, outpatient 71%, p=0.664), nor was there a difference in the number of weeks between MOUD initiation and the first positive urine toxicology (inpatient 4.6 weeks, outpatient 4.3 weeks p=0.906). Finally, rates of positive urine toxicology at delivery were also similar (inpatient 57%, outpatient 53%, p=0.999). When examining neonatal outcomes there were no differences in birthweight percentiles or rates of diagnosis of neonatal abstinence syndrome.

Conclusion: Our data suggest that outpatient/home initiation of MOUD is not associated with significantly different rates non-prescribed substance or adverse neonatal outcomes. In an appropriately counseled patient with comprehensive substance use care in pregnancy outpatient/home MOUD initiation can be considered as an alternative to traditional inpatient initiation.