Extended-release injection vs sublingual buprenorphine for illicit opioid use in pregnant patients with depression and/or anxiety.

In 30 seconds

This exploratory secondary analysis of a parallel-group randomized trial compared extended-release injectable buprenorphine (XR-BUP) with sublingual buprenorphine (SL-BUP) in pregnant adults receiving treatment for opioid use disorder. It examined whether outcomes differed by baseline depression and/or anxiety symptoms, present in 52.1% of participants. Among those screening positive, pregnancy opioid abstinence was higher with XR-BUP than SL-BUP (group difference=12.5%, p = 0.03), and postpartum withdrawal was lower (group difference -2.9, p < 0.01). The authors conclude XR-BUP may offer greater benefits in this subgroup.

Key findings

• For participants with depression and/or anxiety symptoms, pregnancy opioid abstinence favored XR-BUP over SL-BUP (group difference=12.5%, p = 0.03).
• Postpartum withdrawal was lower with XR-BUP than SL-BUP among participants with depression and/or anxiety symptoms (group difference -2.9, p < 0.01).
• Among participants without these symptoms, abstinence and withdrawal differences between formulations were not statistically significant (p = 0.27 and p = 0.47, respectively).
• The proportion screening positive for depression and/or anxiety decreased over time during pregnancy (Odds Ratio=0.27, p < 0.01).

Why it matters

Co-occurring depression or anxiety may be relevant when evaluating buprenorphine formulation outcomes during pregnancy. These subgroup results suggest that formulation-associated differences in abstinence and withdrawal may vary with baseline symptoms, highlighting the value of assessing mental health symptoms alongside opioid treatment outcomes. The findings also address outcomes extending into the postpartum period.

What to keep in mind

This was an exploratory secondary analysis of a randomized trial, so subgroup findings should be interpreted cautiously.