Therapeutic Substitution: A Cogent Response To Opioid Induced Neonatal Abstinence Syndrome (Nas) Crisis

INTRODUCTION: From July 1, 2016 to June 30, 2017 a total of 582 new obstetrical patients were seen in a resident service clinic in the Women's Medicine Center (WMC) at a tertiary care center with 52 (8.9%) screening positive for opiates by urine drug screening. These 52 patients were all offered outpatient therapeutic substitution in an obstetrical-addictions combined clinic to obtain abstinence with oral buprenorphine in a medicated tapering protocol. METHODS: Prospective observational study of patients receiving oral buprenorphine to obtain abstinence from July 1, 2016 to June 30, 2017 at tertiary care center. RESULTS: Of the 52 patients, 20 (38.5%) transferred to other maintenance programs, 11 (21.2%) patients sustained spontaneous miscarriages, 10 (19.2%) were lost to follow up, and three (5.8%) declined enrollment. Eight patients (15%) who enrolled completed the outpatient program. A total of 4 (50%) of babies were born neonatal abstinence (NAS) free, with 3 (100%) from mothers reaching abstinence by time of birth. In comparison, only 1 out of the 5 (20%) babies born to mothers who did not reach abstinence was NAS free. No adverse outcomes were noted in any patients or neonates who entered and/or completed the program. Cost savings for the 3 neonates born abstinent was estimated at over $100,000 in hospital costs alone. CONCLUSION: Outpatient therapeutic substitution with oral buprenorphine to obtain abstinence is possible in pregnant patients and results in significant cost savings. Ongoing efforts with more data are needed to confirm our findings and explore methods for enhanced success in obtaining abstinence.