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. Author manuscript; available in PMC: 2022 Mar 7.
Published in final edited form as: Obstet Gynecol. 2020 Apr;135(4):975. doi: 10.1097/AOG.0000000000003812

Methadone, Buprenorphine, or Detoxification for Management of Perinatal Opioid Use Disorder: A Cost-Effectiveness Analysis

Susan L Calcaterra 1, Kaylin A Klie 2
PMCID: PMC8900872  NIHMSID: NIHMS1666133  PMID: 32217961

In the November 2019 issue, Premkumar et al1 report that buprenorphine was the most cost-effective treatment for opioid use disorder (OUD) in pregnancy. The use of medications for OUD have been shown, time and time again, to result in a reduction in the transmission of infectious diseases,2,3 opioid overdose,4 and mortality.5,6 We were disappointed that the authors described medication-assisted withdrawal as a “treatment” strategy for pregnant women with OUD (last paragraph of the Introduction, second and third paragraphs of the Discussion). Although the overarching message in this article is that health care payers should focus on the overall costs of these three interventions, we believe the authors missed an opportunity to highlight the endorsements for the use of medications for OUD by the American College of Obstetricians and Gynecologists, the Society for Maternal-Fetal Medicine,8 the American Society of Addiction Medicine, the World Health Organization,9 the American Psychiatric Association, and the Substance Abuse and Mental Health Services Administration.10 Women with OUD are at the highest risk of overdose within the first 6 months to 1 year after delivery and should be offered evidence-based, lifesaving medications for OUD treatment when they present for prenatal care.7 Patients, clinicians, and health care systems should be encouraged to carefully consider these recommendations when making decisions for patient care in the 1 year after a pregnancy event. Medication-assisted withdrawal as treatment is not an option. Clinicians less familiar with the robust evidence and society endorsements supporting initiation of medications for OUD may read this article and believe they are providing their pregnant patients with a recognized treatment option when they initiate or recommend medication-assisted withdrawal. We recognize there are areas in the country where access to medications for OUD is limited, and clinicians may have few options to initiate medications for OUD among their patients. Instead of initiating medication-assisted withdrawal, clinicians should themselves obtain an X waiver and provide their patients with the care they deserve.

Acknowledgments

Financial Disclosure: The authors did not report any potential conflicts of interest.

Contributor Information

Susan L. Calcaterra, Department of Medicine, Division of General Internal Medicine, Addiction Medicine, University of Colorado, Aurora, Colorado.

Kaylin A. Klie, Addiction Medicine, Department of Family Medicine, University of Colorado, Aurora, Colorado and Department of Obstetrics and Gynecology, Denver Health Medical Center, Denver, Colorado.

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