(PS1-22) Patient Feedback on a Technology Enhanced Cognitive-Behavioral Intervention for Buprenorphine Retention During Pregnancy

Abstract Text: Opioid use disorder (OUD) and opioid-related overdose are leading causes of maternal mortality in the United States. Medication for Opioid Use Disorder (MOUD) is the first-line treatment for perinatal OUD and reduces the risk of overdose, yet over half of perinatal persons discontinue treatment by 6 months postpartum. MOUD discontinuation is driven by structural barriers (e.g., lack of childcare) and transdiagnostic psychological risk factors common during pregnancy and linked with opioid use, including anxiety sensitivity and sleep deficiency. EMpowering Pregnant Women and people Receiving MOUD (EMPWR) is a novel telemedicine-based CBT intervention and adjunctive mobile application for perinatal persons to improve retention in MOUD treatment by mitigating the structural barriers and psychological risk factors contributing to MOUD disengagement. EMPWR leverages technology to overcome structural barriers, and interoceptive exposures and CBT for Insomnia (CBTI) to mitigate anxiety sensitivity and sleep deficiencies, respectively. We elicited feedback from pregnant and postpartum people with OUD on the desirability of EMPWR, its relevancy to their experiences and goals, and potential modifications. Participants were nine women (Mage = 28.0, 77.8% White, 100% cisgender) who were pregnant (55.6%) or postpartum (44.4%) and had current or past treatment with MOUD, who participated in individual interviews or focus groups. Participants watched therapy vignette videos with demonstrations of CBTI and interoceptive exposure. Interviews and focus groups were transcribed and coded using thematic analysis. All participants stated they would have wanted to receive EMPWR if offered to them, appreciating that it provided a different approach compared to traditional recovery management treatment programs. Overall, participants perceived that EMPWR and its goal to improve MOUD retention was highly relevant to their goals and experiences as mothers in recovery and appreciated that it would foster routine and structure. The ease and convenience of a mobile app relevant to their personal experience was highlighted. Participants were enthusiastic about sleep-related stimulus control to improve quantity and quality of sleep during the perinatal period, and all participants stated they would practice interoceptive exposures during pregnancy to improve their self-efficacy to cope with anxious arousal associated with opioid withdrawal anxiety. Participants provided recommendations to increase authenticity and potency of exposures. A technology-enhanced CBT intervention to improve retention in MOUD treatment during the perinatal period is not only necessary due to high rates of MOUD discontinuation and subsequent overdose but is desired among perinatal persons with OUD. Interoceptive exposure and CBTI are acceptable to pregnant patients with OUD, and inclusion of accessible technology in adjuvant CBT for medication management that can promote daily adherence and bridge the gap between therapy sessions is well-liked by patients. Research is ongoing to determine the feasibility of the EMPWR model, and future clinical trials are needed to evaluate the efficacy of using CBT for MOUD retention during and after pregnancy.