Abstract
Background: Opioid use disorder (OUD) during pregnancy is a leading contributor to peripartum morbidity and mortality, with overdose deaths rising significantly in recent years. Despite the identification of various factors associated with overdose events, including social, demographic, psychiatric, and neonatal outcomes, the relative contributions of these factors to peripartum overdose history (or lack thereof) remain unclear. Thus, this study aims to characterize factors associated with lifetime opioid-involved overdose events among currently pregnant individuals receiving buprenorphine (BUP) treatment for OUD. Methods: Treatment-seeking pregnant individuals with an estimated gestational age of 6 to 30 weeks were enrolled in a large multisite randomized controlled trial evaluating 2 BUP formulations for OUD. Participant baseline demographic, substance use, and mental health data were collected using validated measures, and random forest modeling identified key factors associated with lifetime opioid overdose events. Results: The 140 pregnant participants (Mage = 31.2 years, SD = 4.7; 87.1% White) reported an average of 8.7 years (SD = 5.8) of opioid use, with 92.1% endorsing lifetime prescription opioid use and 82.9% reporting heroin use. The average lifetime number of nonfatal opioid overdose events was 4.8 (SD = 12.1); an overdose was reported by 55% of the sample (n = 77). Random forest analysis (area under the receiver operating characteristic curve = 0.797) incorporating sociodemographic, substance use, and mental health characteristics found that the most important factors associated with lifetime overdose events were, in order, lifetime heroin use, trauma exposure, reliance on partners or parents for financial support, depressive symptoms, and lifetime cocaine use. Conclusions: These findings underscore the critical need to address substance use, co-occurring mental health, and socioeconomic challenges that are associated with previous opioid overdose. Identifying and targeting key modifiable overdose risk factors can inform the development of tailored interventions to improve outcomes for this population.
| Original language | English |
|---|---|
| Journal | Substance Use and Addiction Journal |
| DOIs | |
| State | Accepted/In press - 2026 |
Bibliographical note
Publisher Copyright:© 2026 by AMERSA, Inc.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institutes of Health through the NIH HEAL Initiative under award numbers UG1DA013732 to the University of Cincinnati (John T. Winhusen), UG1DA049444 (Adam Gordon and Gerald Cochran), UG1DA015831 (Roger Weiss and Gail D’Onofrio), UG1DA013727 (Kathleen Brady and Kelly Barth), UG1DA049468 (Kimberly Page), UG1DA015815 (Keith Humphreys and Todd Korthuis), UG1DA013720 (Jose Szapocznik, Daniel Feaster, and Lisa Metsch), UG1DA049436 (Jane Liebschutz and Judith Feinberg), and UG1DA013714 (John Roll and Mary Hatch-Maillette). The work was also supported by NIDA contracts to the CCC (HHSN271201500065C) and DSC (HHSN271201400028C). The Publications Committee of the National Drug Abuse Treatment Clinical Trials Network reviewed and gave approval for submission of this manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or its NIH HEAL Initiative.
| Funders | Funder number |
|---|---|
| John Roll and Mary Hatch-Maillette | |
| National Institute on Drug Abuse | |
| University of Cincinnati University Research Council | UG1DA013720, UG1DA049468, UG1DA015831, UG1DA049436, UG1DA049444, UG1DA013727, UG1DA015815, UG1DA013714 |
| National Institutes of Health (NIH) | UG1DA013732 |
| DSC | HHSN271201400028C |
| Crohn's and Colitis Canada | HHSN271201500065C |
Keywords
- opioid overdose
- opioid use disorder
- pregnancy
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Psychiatry and Mental health
