Advancing MOUD Integration and Addressing Retention Challenges in Pregnant women with Opioid use disorder: Study

Treatment retention among pregnant individuals with opioid use disorder (OUD) is essential, particularly in the context of the rising prevalence of high-potency synthetic opioids (HPSOs). A thorough examination of the relationship between the inclusion of medication for opioid use disorder (MOUD) in treatment and six-month retention rates was conducted among pregnant individuals in publicly funded specialty substance use treatment facilities. Recognizing the grave risks associated with untreated OUD during pregnancy—such as increased overdose rates and adverse neonatal outcomes—recent study underscores the necessity of maintaining an effective treatment regimen. Utilizing episode-level data from treatment facilities, the research included 29,981 treatment episodes for pregnant individuals who reported opioids as their primary substance. Analysis focused on the association between MOUD inclusion—specifically methadone, buprenorphine, or naltrexone—and retention beyond six months, using inverse probability of treatment (IPT)-weighted logistic regression models to account for potential confounding factors. Findings indicated that about 68.4% of treatment episodes included MOUD, reflecting a notable increase from 65.0% in 2015 to 74.1% in 2021.

Results of MOUD Inclusion

Results revealed that inclusion of MOUD was associated with a significant 10.8 percentage point increase in the likelihood of treatment retention beyond six months. Key demographic trends emerged, indicating higher MOUD inclusion among older individuals and certain racial/ethnic minorities. Despite these positive associations, overall retention rates for this population remain suboptimal, with patterns similar to those observed in chronic disease management, suggesting the need for better engagement and support strategies. Limitations of the study include possible underreporting of treatment episodes and the inability to differentiate types or dosages of MOUD used. It also addresses potential discrepancies regarding state-level policies, as restrictive child maltreatment laws appear to inhibit MOUD receipt among pregnant individuals. Despite these limitations, the evidence demonstrates that integrating MOUD into treatment plans significantly enhances retention, an essential metric during a period marked by increasing overdose risks associated with HPSOs.

Conclusions and Recommendations

In conclusion, this investigation highlights both the advancements in MOUD acceptance and the persistent challenges in treatment retention for pregnant individuals facing OUD. Recommendations suggest a need for continued policy interventions to facilitate increased MOUD incorporation in treatment protocols, ultimately aiming to improve health outcomes for both mothers and infants in this vulnerable demographic.

Key Points

- Treatment retention in pregnant individuals with opioid use disorder (OUD) is critical, particularly given the rising prevalence of high-potency synthetic opioids (HPSOs), which can lead to increased overdose and adverse neonatal outcomes when left untreated.

- An analysis was conducted using episode-level data from 29,981 treatment cases in publicly funded specialty substance use treatment facilities, focusing on the relationship between the inclusion of medication for opioid use disorder (MOUD) and six-month retention rates.

- Approximately 68.4% of the treatment episodes included MOUD, showing an increase from 65.0% in 2015 to 74.1% in 2021, indicating a growing acceptance of MOUD in treatment plans for OUD during pregnancy. - The inclusion of MOUD was associated with a significant 10.8 percentage point increase in the likelihood of treatment retention beyond six months, highlighting its importance in improving outcomes for this demographic.

- Demographic analysis showed higher MOUD inclusion rates among older individuals and specific racial/ethnic minority groups, yet overall retention rates remain suboptimal, suggesting a need for enhanced engagement and support strategies in treatment.

- Limitations included potential underreporting of treatment episodes and inability to specify types or dosages of MOUD, along with concerns that restrictive child maltreatment laws may impede MOUD access for pregnant individuals, emphasizing the importance of ongoing policy advocacy to improve treatment protocols and health outcomes for mothers and infants.

Reference –

Valerie S. Ganetsky et al. (2025). Medication For Opioid Use Disorder And Treatment Retention Among Pregnant Individuals. *JAMA Network Open*, 8. https://doi.org/10.1001/jamanetworkopen.2025.6069.