Long-Acting Injectable Buprenorphine in Pregnancy

To describe real-world use of long-acting injectable buprenorphine among pregnant individuals with opioid use disorder (OUD), including monthly formulations and initiation among those not previously stable on sublingual buprenorphine.

We conducted a retrospective chart review of inpatient and outpatient medical records of pregnant individuals with OUD who received at least one dose of long-acting injectable buprenorphine during pregnancy while admitted at a large academic medical center. Dosing patterns, supplemental sublingual buprenorphine use, treatment retention, and maternal outcomes were described.

Between January 1, 2024, and February 1, 2026, 12 pregnant individuals received long-acting injectable buprenorphine. Most received monthly formulations (11 of 12). Ten patients (83.3%) initiated treatment with long-acting injectable buprenorphine during pregnancy through low-dose buprenorphine initiation; two continued long-acting injectable buprenorphine that was started before pregnancy. Median gestational age for those who initiated long-acting injectable buprenorphine during pregnancy was 30 weeks (range 11-33 weeks). All patients newly initiated on long-acting injectable buprenorphine reported nonprescribed fentanyl use before treatment. Supplemental sublingual buprenorphine was prescribed for all participants initiating long-acting injectable buprenorphine (median 20 mg/d, range 12-32 mg/d). Four who initiated long-acting injectable buprenorphine transitioned to methadone during pregnancy because of persistent cravings or withdrawal. At delivery, retention on long-acting injectable buprenorphine was 66.7%, and 91.7% remained on any medication for OUD (MOUD).

Among pregnant individuals who received long-acting injectable buprenorphine, including those with nonprescribed fentanyl use initiating treatment during pregnancy, retention on MOUD through delivery was high, and supplemental buprenorphine was commonly prescribed. Some patients transitioned to methadone, underscoring the importance of individualized treatment and counseling regarding formulation-specific considerations.