O’Connor AB, Smith J, O’Brien LM, Lamarche K, Byers N, Nichols SD. Peripartum and Postpartum Analgesia and Pain in Women Prescribed Buprenorphine for Opioid Use Disorder Who Deliver by Cesarean Section. Subst Abuse. 2022;16:11782218221107936. Published 2022 Jun 21. doi:10.1177/11782218221107936
Our retrospective case-controlled study found that people who are delivering a baby via C-Section and receiving chronic buprenorphine therapy at doses >8mg can achieve adequate analgesia with full opioid agonists and safely remain on their >8mg prescribed home dose. This is significant because buprenorphine is first-line therapy for opioid use disorder and > 8mg dose is necessary for reducing nonprescribed opioid use. Pregnant people have expanded blood volume and a larger volume of buprenorphine distribution resulting in significantly lower levels. Current C-section pre-operative care includes discontinuing or lowering buprenorphine to 8mg. Reducing buprenorphine dose or discontinuing therapy pre-delivery places the patient at greater risk for overdose due to increased stress of childbirth and caregiving responsibilities combined with loss of robust OUD treatment. This evidence contributes to a growing body of evidence that illustrates the safety of continuing a pregnant person’s home buprenorphine dose throughout the delivery and post-acute hospital recovery period.