Extended-Release Buprenorphine in Pregnancy

Sublingual buprenorphine is an evidence-based treatment for pregnant patients with opioid use disorder (OUD), but it requires daily adherence and produces fluctuating drug levels. Extended-release buprenorphine offers more-stable pharmacokinetics and eliminates daily dosing, though limited randomized data and concerns about fetal drug exposure have constrained its use during pregnancy.

In this multicenter, open-label trial, 140 pregnant patients with OUD (6–30 weeks’ gestation) were randomized to receive weekly injections of extended-release buprenorphine or daily sublingual therapy. Patients attended weekly visits through 12 months postpartum, with abstinence assessed by urine testing.