Study Finds Racial Disparities in Buprenorphine Treatment Retention During Pregnancy

Medication treatment with buprenorphine or methadone is the standard of care for opioid use disorder (OUD) during pregnancy, but new findings indicate that treatment retention may differ substantially by race and medication. Black patients initiating buprenorphine experienced significantly higher discontinuation rates during pregnancy and through 1 year postpartum than White patients, according to a nationwide Medicaid cohort study published in JAMA Psychiatry.¹

Treatment retention is particularly important because medication for OUD (MOUD) reduces opioid cravings and withdrawal symptoms, supports engagement with prenatal care, and is associated with lower risks of overdose and all-cause mortality. Current recommendations favor buprenorphine or methadone over withdrawal management during pregnancy and support continuing treatment after delivery.^2,3

Study Evaluates More Than 8500 Pregnancies

Investigators used nationwide Medicaid data from 2010 through 2018 to identify pregnancies resulting in live births among patients aged 12 to 55 years who had an OUD diagnosis and initiated buprenorphine—with or without naloxone—or methadone within 240 days of their estimated last menstrual period.¹

The analysis included 8572 pregnant patients with a mean age of 28 years. Of these, 5482 initiated buprenorphine and 3090 initiated methadone. White patients represented 85.0% of buprenorphine initiators and 75.5% of methadone initiators. Black patients accounted for 4.4% and 9.1% of the respective treatment groups, whereas Hispanic patients represented 4.4% and 9.4%.¹

Treatment discontinuation was defined as a gap of at least 60 days following the end of the last buprenorphine prescription’s days’ supply or the last recorded methadone administration code. Patients were followed from treatment initiation through the end of pregnancy and for up to 1 year postpartum.¹

Buprenorphine Discontinuation Disparity Was Most Pronounced

At 180 days after buprenorphine initiation, 45.0% of Black patients had discontinued treatment compared with 27.0% of White patients. After adjustment for patient characteristics, Black patients had a 69% higher risk of buprenorphine discontinuation during pregnancy than White patients (adjusted hazard ratio [AHR], 1.69; 95% CI, 1.32-2.16).¹

The disparity remained when follow-up was extended through 1 year postpartum, with Black patients experiencing a 51% higher adjusted risk of buprenorphine discontinuation (AHR, 1.51; 95% CI, 1.28-1.77).¹

Differences were smaller among methadone initiators. At 180 days, treatment had been discontinued by 26.8% of Black patients and 23.0% of White patients. The difference during pregnancy was not statistically significant (AHR, 1.17; 95% CI, 0.86-1.59). However, through 1 year postpartum, Black patients had a significantly higher discontinuation risk (AHR, 1.22; 95% CI, 1.03-1.44).¹

No substantial differences were identified between White patients and those classified as another or unknown race or ethnicity. However, the investigators cautioned that combining several racial groups into a heterogeneous category limited interpretation.¹

Findings Point to Structural Barriers, Not Medication Effectiveness

The observational results do not establish why disparities occurred. Nevertheless, differences in how the medications are accessed may be relevant. Buprenorphine can be dispensed through community pharmacies following an office-based prescription, whereas methadone for OUD is generally administered through federally certified opioid treatment programs. Each pathway may introduce distinct barriers involving transportation, pharmacy availability, insurance processes, stigma, continuity of care, or coordination between obstetric and addiction treatment teams.⁴

Claims data also could not confirm whether patients took dispensed buprenorphine, capture methadone treatment that was not billed to Medicaid, or account for every clinical and social factor influencing retention. The cohort was limited to publicly insured pregnancies resulting in live births, and the data predated several more recent changes in buprenorphine prescribing and methadone policy.¹

Pharmacists Can Help Protect Treatment Continuity

Pharmacists can help identify treatment gaps before they become prolonged interruptions, particularly during transitions from pregnancy to postpartum care. Proactive refill monitoring, rapid resolution of coverage or dispensing barriers, nonstigmatizing counseling, naloxone access, and direct communication with obstetric and addiction care teams may support continuity.

Medication discontinuation should not be treated as a patient-level failure. The findings underscore the need to assess whether pharmacy access, fragmented care, transportation burdens, discriminatory treatment, or other structural conditions disproportionately undermine retention among Black patients. Because postpartum patients face heightened vulnerability to recurrence of opioid use and overdose, treatment continuity should remain an active priority well beyond delivery.^2,3

REFERENCES

1. Zakoul H, Lin CG, Straub L, et al. Racial and ethnic disparities in treatment discontinuation in pregnant females with opioid use disorder. JAMA Psychiatry. Published online August 19, 2026. doi:10.1001/jamapsychiatry.2026.2506

2. Centers for Disease Control and Prevention. Treatment of opioid use disorder before, during, and after pregnancy. Updated May 1, 2026. Accessed August 19, 2026. https://www.cdc.gov/opioid-use-during-pregnancy/treatment/index.html

3. Centers for Disease Control and Prevention. Opioid use and pregnancy. Updated February 11, 2025. Accessed August 19, 2026. https://www.cdc.gov/overdose-prevention/hcp/clinical-care/opioid-use-and-pregnancy.html

4. Substance Abuse and Mental Health Services Administration. Federal Guidelines for Opioid Treatment Programs 2024. Published December 2024. Accessed August 19, 2026. https://library.samhsa.gov/product/federal-guidelines-opioid-treatment-programs-2024/pep24-02-011