Drug and Alcohol Dependence 149 (2015) 225–231 Contents lists available at ScienceDirect Drug and Alcohol Dependence journal homepage: www.elsevier.com/locate/drugalcdep Medication assisted treatment discontinuation in pregnant and postpartum women with opioid use disorder Christine Wilder a,b,* , Daniel Lewis a , Theresa Winhusen a a Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA b Department of Veterans Affairs Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA article info Article history: Received 14 August 2014 Received in revised form 4 February 2015 Accepted 6 February 2015 Available online 19 February 2015 Keywords: Opioid use disorder Pregnancy Postpartum Medication assisted treatment Methadone Patient dropout abstract Background: Increasing use of opioids has led to an increase in the number of pregnant and postpartum women in medication assisted treatment (MAT) for opioid use disorder. Methods: We (1) conducted a systematic review of published literature on MAT discontinuation (methadone and buprenorphine) in pregnant and postpartum women and (2) determined methadone discontinuation rates in a retrospective cohort (2006–2013) of pregnant and postpartum women in a university affiliated methadone clinic. Results: We found limited generalizable literature reports of discontinuation rates, with a range of prenatal discontinuation rates from 0 to 33% and rates which spanned various prenatal and postnatal periods from 26 to 64%. In our cohort of 229 women, 251 pregnancies were reported, with a prenatal methadone discontinuation rate of 11.0%. Based on a Cox proportional hazards model controlling for age, pregnancy outcome, and duration of treatment prior to delivery, the probability of methadone discontinuation at or before 6 months postpartum was 56.0%. Duration of methadone treatment prior to delivery was inversely associated with risk for postpartum discontinuation of treatment (HR = 0.98, 95% CI (0.96, 0.99)). Conclusions: We conclude that the postpartum period is a time of increased risk for discontinuation of MAT. More accurate assessment of rates of pre- and postpartum MAT discontinuation, as well as further investigation of factors affecting these rates, is warranted. Development and testing of interventions to encourage early prenatal enrollment in MAT and improve postnatal retention in MAT would benefit pregnant women and new mothers with opioid use disorder. Published by Elsevier Ireland Ltd. 1. Introduction The percentage of pregnant women who use opioids has tripled in the last ten years, with 1.2% of all pregnant women reporting opioid use in 2012 (Substance Abuse and Mental Health Services Administration, 2003, 2013). Pregnant women face severe, long- term consequences of drug use, including an increased likelihood of assault and abuse, contracting HIV or hepatitis, miscarriage, delivering infants with physical and behavioral impairments, post- partum depression, and loss of custody of their children (Dakof et al., 2003; Dansky et al., 1999; Holbrook and Kaltenbach, 2012; Kissin et al., 2001). Pregnant women using illicit opioids expose themselves and their fetuses to additional risks specific to * Corresponding author at: Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 3131 Harvey Avenue, Cincinnati, OH 45229, USA. Tel.: +1 513 585 8285; fax: +1 513 585 8278. E-mail address: Christine.wilder@uc.edu (C. Wilder). opioid use, including pregnancy complications, premature labor, low birth weight, and spontaneous abortion (American Congress of Obstetricians and Gynecologists, 2012; Hulse et al., 1998; Kandall et al., 1999; Ludlow et al., 2004). Medication assisted treatment (MAT) with methadone or, more recently, buprenorphine is the most effective treatment for opioid use disorder (OUD) in pregnant women (American Congress of Obstetricians and Gynecologists, 2012; Jones et al., 2012; Minozzi et al., 2013) and those in MAT have better maternal and fetal outcomes than those not enrolled in treatment (Burns et al., 2007; Fajemirokun-Odudeyi et al., 2006; Welle-Strand et al., 2013). Some studies have also shown a relation- ship between length of time in methadone treatment and improved fetal outcomes (Burns et al., 2007; Peles et al., 2012). Although the effectiveness of MAT exclusively in postpartum women has not been studied, MAT is considered a highly effective treatment for OUD in the general non-pregnant population (Mattick et al., 2009), which includes postpartum women. Because MAT has such strong evidence for improved treat- ment outcomes, retention of patients in MAT is critical. Treatment http://dx.doi.org/10.1016/j.drugalcdep.2015.02.012 0376-8716/Published by Elsevier Ireland Ltd.