Geographic differences in buprenorphine and methadone prescribing for surgical patients with opioid use disorder.

Background: Patients with opioid use disorder (OUD) frequently present for surgery while receiving medications for OUD (MOUD), typically buprenorphine or methadone. This study evaluated MOUD use among surgical patients with OUD in a health-system spanning both urban and rural areas in Maine; a predominantly rural state with a significant opioid crisis. Methods: We retrospectively identified adult surgical patients with OUD admitted to MaineHealth hospitals from 2014 to 2023 who were receiving MOUD prior to the day of surgery. Demographics and clinical characteristics were collected; rural designation was determined using Rural-Urban Commuting Area codes. The primary outcome was the temporal trend in proportion of surgical patients with OUD receiving methadone versus buprenorphine prior to admission. Temporal trends and geographic differences were compared using chi-square tests (p < 0.05). Results: Of 2099 surgical patients on MOUD, 71.4 % received buprenorphine and 28.6 % methadone. Overall, rural patients were more likely to receive buprenorphine than urban patients (75.1 % vs. 68.5 %) (p < 0.001). Buprenorphine prescribing increased from 52.0 % to 84.2 % in rural areas and from 59.3 % to 72.9 % in urban areas, with corresponding declines in methadone use (both p < 0.05). Conclusions: Temporal trends showed a significant shift in MOUD prescribing over the study period, with buprenorphine use increasing and methadone use declining in rural and urban populations. Although both medications are considered safe in hospitalized and surgical patients, perioperative management remains inconsistent. Further work is needed to evaluate how these prescribing trends influence clinical outcomes and ensure perioperative protocols support continuity of care for patients with OUD.