Getting someone started on medication matters but keeping them connected to treatment matters just as much.
Hazem Zakoul of the Johns Hopkins Bloomberg School of Public Health led the research team. The researchers reviewed national Medicaid data from 2010 through 2018.
Their analysis covered 8,572 pregnancies among patients ages 12 to 55 with opioid use disorder who started buprenorphine or methadone within 240 days of their estimated last menstrual period.
The Numbers Behind the Treatment Gap
Of the 8,572 patients in the study 5,482 started buprenorphine and 3,090 started methadone. White patients made up 85% of those who started buprenorphine, and 75.5% of those who started methadone. Black patients accounted for 4.4% and 9.1% of the two groups.
After accounting for patient characteristics the researchers found a 69% higher risk of discontinuation among Black patients during pregnancy.
The gap didn’t end with childbirth, black patients faced a 51% higher adjusted risk of stopping buprenorphine during the first year postpartum.
With methadone, at the 180 day mark 26.8% of Black patients had stopped treatment compared with 23% of White patients. Researchers didn’t find a statistically significant difference during pregnancy but a significant gap appeared after delivery.
Buprenorphine and methadone remain standard treatments because staying on medication links to lower risks of overdose and death from any cause.
Why Staying on Medication Matters
Starting treatment is one thing but staying on it through pregnancy and after delivery can be much harder.
Medication for opioid use disorder assists with control cravings and supports engagement with prenatal care. It also lowers the risk of overdose and death.
Clinical guidance generally recommends continuing medication through delivery and beyond, when appropriate. Stopping treatment early can leave patients without those benefits.
The researchers point to barriers within the healthcare system, rather than a lack of commitment from patients. Buprenorphine often comes from a community pharmacy.
That means someone may need reliable transportation and insurance coverage that works without delays. Refill schedules can create another hurdle. Stigma at the pharmacy counter may add to the pressure.
Methadone treatment usually involves daily visits to an opioid treatment program. Those visits can create logistical problems of their own but they also provide regular contact with treatment staff.
The researchers suggest several ways to help patients stay on medication. Pharmacies could monitor refills and flag missed pickups. Providers could resolve insurance problems sooner and offer counseling without judgment. Naloxone access and better communication between obstetric and addiction care teams may also help.
Questions to Ask When Choosing Treatment
Pregnant people with opioid use disorder and the families supporting them may want to ask how a program handles the details of ongoing care. Does the team coordinate with pharmacies? Does someone follow up when a patient misses an appointment or fails to collect a prescription? What support continues after delivery?
That last question deserves particular attention. The study found that disparities continued into the postpartum period. A program that plans for pregnancy but gives little attention to the months after birth may leave patients without enough support during a difficult transition.
Stopping medication shouldn’t be treated as a personal failure. Access problems and gaps in follow-up can interrupt care even when someone wants to continue treatment. Providers need to recognize those barriers and work with patients to address them.
Finding Treatment for Opioid Use Disorder During Pregnancy
When comparing addiction treatment programs, look for services that offer medication for opioid use disorder and coordination with prenatal care. Postpartum support matters too. Confirm that the program treats pregnant patients and accepts Medicaid before making a decision.
Rehab.com offers a directory of treatment centers across the country. Call
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to speak with a treatment advisor about options for pregnancy and opioid use disorder.
