Maternity Care and Buprenorphine Prescribing in New Family Physicians

The Article in Brief

Maternity Care and Buprenorphine Prescribing in New Family Physicians

Joshua St. Louis , and colleagues

Background Data focused on opioid-use disorder (OUD) among pregnant women shows that opioid-related overdoses constitute a major contribution to pregnancy-related mortality despite the existence of effective treatment options. The Federal Drug Administration has approved the use of both methadone and buprenorphine for management of OUD during pregnancy. While methadone is obtained by visiting a federally certified outpatient treatment center daily to receive a dose, pregnant women can get buprenorphine in primary care. Physicians, nurse practitioners (NPs), and physician assistants (PAs) can prescribe buprenorphine for treatment of OUD to patients in their care, including pregnant women, after completing a brief training course (8 hours for physicians and 24 hours for NPs and PAs). Medication-assisted treatment has been shown to decrease mortality from OUD as well as to decrease overdose, acquisition of HIV and hepatitis C, and relapse, in comparison with abstinence-based treatment. Yet only 10.6% of patients with OUD are receiving treatment, and women with OUD still experience high rates of overdose and mortality, particularly in the postpartum period.

What This Study Found The research team behind this study sought to characterize the recently trained family medicine workforce that may be providing buprenorphine to pregnant patients. Using data from the 2016, 2017 and 2018 National Family Medicine Graduate Survey, administered annually by the American Board of Family Medicine, they asked clinicians who graduated from family medicine residency programs within the past three years whether "maternity care" or "buprenorphine treatment" were part of their practice and whether they were currently delivering babies. Of the 5,103 respondents in their sample, 153 both deliver babies and prescribe buprenorphine. A further 108 respondents provide maternity care and prescribe buprenorphine but do not perform deliveries. The researchers note that it is not clear whether the surveyed physicians are necessarily providing pregnancy care and prescribing buprenorphine to the same patients. Of 614 total family medicine residencies represented in the survey, only 15 of them, mostly in urban areas on the East and West Coasts, trained 25% of the respondents who provide this care. Early-career family physicians who both provide maternity care and prescribe buprenorphine primarily completed their training in a small number of residency programs. As data about the risks of maternal mortality from substance use disorder emerges, it will be important to increase training opportunities in family medicine residencies to meet the needs of pregnant women with substance use disorder.

Implications

• The workforce of family physicians providing coordinated care for pregnant women with OUD in the United States appears to be small, concentrated in urban areas, and is overwhelmingly comprised of family physicians who trained in a small number of residency programs.
• Innovative solutions for improving access to this particularly vulnerable patient population should focus on incentivizing integration of buprenorphine training into more family medicine and OB/GYN residency programs, especially those found in rural areas of the United States.