Longer MOUD Use During Pregnancy and Postpartum Linked to Lower Overdose or Death Risk

Longer use of medications for opioid use disorder (MOUD) during pregnancy and early post partum was associated with a lower risk of overdose or death in the first year post partum, according to a retrospective cohort study published in JAMA Network Open.

The investigators used Tennessee Medicaid (TennCare) data linked to vital records and hospital discharge data. The study included individuals aged 15 to 44 years who delivered between 2007 and 2020. Each had at least 1 day of dispensed buprenorphine and/or naltrexone between 90 days before and 41 days after delivery. Methadone was not included because TennCare did not cover it for this purpose until 2020. The primary outcome was all-cause death or overdose from 42 to 365 days post partum.

The cohort included 9360 pregnancies among 7776 individuals (median age at delivery, 27 years), and 97.06% of pregnancies involved buprenorphine only. The median MOUD duration during the 132-day exposure period was 88 days. The 1-year postpartum risk of death or overdose was 1.58%. Longer MOUD duration was associated with lower risk, and the lowest hazard was at 132 days' supply compared with 1 day (adjusted hazard ratio, 0.52; 95% CI, 0.31-0.88). Results were consistent across sensitivity analyses, including when exposure was restricted to buprenorphine days only.

Among individuals who received MOUD both before and after delivery, the 1-year risk of death or overdose was 1.41%. The authors described this as an exceptionally high risk even with optimal treatment.

The authors noted that the small number of outcomes introduced the possibility of residual confounding. The study also did not compare treated with untreated individuals. They added that longer MOUD duration may be a marker of treatment engagement, continuity of care, and other factors associated with overdose risk.

Source: Kim A, Wiese AD, Osmundson S, et al. Duration of medication use for opioid use disorder and risk of postpartum overdose and death. JAMA Netw Open. 2026;9(10):e2637214. doi:10.1001/jamanetworkopen.2026.37214