A Pilot Study of Patient Navigation for Pregnant Women with Opioid Use Disorder Initiating Medication Assisted Treatment

Background and Purpose: The clinical and public health impact of opioid use disorder (OUD) among pregnant women has dramatically increased in recent years. OUD positive women have been previously documented to have disproportionally high psychiatric and non-opioid substance use disorders. The standard of care for pregnant women with OUD is medication assisted treatment (e.g. buprenorphine, methadone) along with adjunctive psychosocial treatment. The current literature in the field is not clear regarding the optimal adjunctive treatment for opioid maintenance among this population. This pilot project assessed a patient navigation (PN) intervention to: reduce opioid/other substance use, enhance treatment engagement, and improve mental health and quality of life among pregnant women with OUD.

Methods: A one-group repeated measures design was implemented wherein pregnant women with OUD initiating buprenorphine maintenance were recruited from the UPMC Magee-Women’s Hospital Pregnancy Recovery Center clinic, an office-based buprenorphine treatment program that provides prenatal care and focused case management. Eligible women who consented received 10 PN sessions prior to delivery and 4 sessions postnatally. The PN model delivered employs strength-based case management and motivational interviewing to link women to appropriate medical, psychosocial, and behavioral health services. Participants who experienced drug use relapse or elected to receive care elsewhere were discharged early from the clinic but continued to receive PN services from the study team (discharged for relapse: n=6, 28.5%, discharged electing to receive care elsewhere: n=2; 9.5%). Participants completed assessments at baseline and at completion of the prenatal and postnatal intervention sessions. Demographics were assessed using descriptive statistics, and adjusted general estimating equation analyses were used to examine improvements in health and service engagement across time. We tested interaction effects between discharge status and time to assess if women discharged early experienced worse outcomes compared to those who continued in the clinic through delivery.  

Results: A total of 21 women were enrolled, received the PN intervention, and completed the follow up assessments. The average number of substance use treatment days in the 28 days prior to the baseline assessment was 1 (SD=1.65). Nearly all participants at baseline screened positive for depression (90%; n=19), and 19% (n=4) were positive for anxiety. For baseline physical health, women on average reported little physical pain (Mean [M]=3.9, SD=1.53) and good general health (M=2.8, SD=0.62).  Outcome analyses showed participants experienced improvements in illicit opioid abstinence (B=0.15, 95% CI=0.1-0.2), other drug use (Odds Ratio [OR]=5.25, 95% CI=2.1-13.0), and depression (OR=7.70, 95% CI=2.4-25.1). Results also showed non-significant improvements in general health (B=0.17, p=0.06, 95% CI= 0.0-0.3) and increased days of attendance for substance use treatment (B=2.15, p=0.07, 95% CI= -0.2-4.5). The majority of study participants achieved adequate or better prenatal care. Interactions for early discharge status and time were not significant for any study outcome (p>0.05).

Conclusions and Implications: These findings suggest PN is a feasible adjunctive intervention that shows promise for health improvements and service engagement among pregnant women with OUD initiating buprenorphine. Future research should seek to replicate the current study within a larger patient population employing a more rigorous randomized research design.