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Buprenorphine for Opioid Use Disorders during Pregnancy: A Review of Comparative Clinical Effectiveness, Safety, Cost-Effectiveness, and Guidelines

Last updated: May 9, 2019
Project Number: RC1111-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of various buprenorphine or buprenorphine-naloxone formulations versus other buprenorphine formulations for the treatment of opioid use disorders during pregnancy?
  2. What is the clinical evidence regarding the safety of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders during pregnancy?
  3. What is the cost-effectiveness of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders during pregnancy?
  4. What are the evidence-based guidelines regarding the use of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders during pregnancy?

Key Message

This report identified a lack of evidence regarding the comparative effectiveness, safety, and cost-effectiveness of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders during pregnancy. Three relevant evidence-based guidelines were identified. Two of three guidelines contained relevant recommendations that reflected this lack of high-quality comparative evidence. These two guidelines recommended buprenorphine treatment in preference to the buprenorphine-naloxone formulation for opioid use disorders during pregnancy. One other Canadian guideline cited the same evidence to support the use of buprenorphine-naloxone as a safe and effective alternative to buprenorphine alone during pregnancy. No additional recommendations for various buprenorphine or buprenorphine-naloxone formulations during pregnancy were identified. Evidence-based treatment of pregnant patients with opioid use disorders requires further well-controlled studies for various buprenorphine and buprenorphine-naloxone formulation treatment options.