Extended-Release Buprenorphine Linked to Higher Opioid Abstinence in Pregnancy Than Daily Treatment

A randomized clinical trial published in JAMA Internal Medicine found that weekly extended-release buprenorphine during pregnancy was associated with higher rates of abstinence from illicit opioids than daily sublingual buprenorphine among pregnant women with opioid use disorder. Overall maternal and infant outcomes were similar between groups. However, the extended-release buprenorphine group reported fewer serious adverse events, less use of pain medication after delivery, and lower postpartum anxiety scores, supporting its use as a treatment option during pregnancy.

The study included 140 pregnant women with opioid use disorder across 13 outpatient treatment sites across the United States, and followed participants through pregnancy and 12 months postpartum. Participants entered the study between 6 and 30 weeks of gestation (average ~21 weeks), and most were already receiving sublingual buprenorphine at enrollment. Researchers compared extended-release and sublingual buprenorphine on maternal abstinence, infant outcomes, and safety measures.

Key Findings

• Participants receiving extended-release buprenorphine had higher illicit opioid abstinence rates (82.5%) compared to those receiving sublingual buprenorphine (72.6%).
  

• Serious maternal adverse events were less common in the extended-release group during both pregnancy and the postpartum period.
  

• Infant outcomes, including the need for and duration of treatment for neonatal opioid withdrawal syndrome (NOWS), did not significantly differ between groups.
  

• Participants receiving extended-release buprenorphine had more consistent medication adherence during pregnancy, as the weekly dosing reduced the need for daily self-administration required with sublingual treatment.
  

• Postpartum abstinence declined and was similar in both groups (~60%), underscoring ongoing risks and the importance of sustained care during the postpartum period.

The authors note the findings support weekly extended-release buprenorphine as an effective treatment option during pregnancy and suggest it may offer some advantages over sublingual buprenorphine for maternal outcomes. They also noted that continued care remains important after delivery, as opioid abstinence declines.

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The Article: Winhusen, T. J., Lofwall, M. R., Kropp, F., et al. (2026). Extended-release vs sublingual buprenorphine in pregnancy through 12 months post partum: A randomized clinical trial. JAMA Internal Medicine. Advance online publication. doi:10.1001/jamainternmed.2026.0057

Read NIDA release: https://www.nih.gov/news-events/news-releases/clinical-trial-results-support-use-weekly-extended-release-buprenorphine-treatment-opioid-use-disorder-during-pregnancy