JAMA Intern Med

Weekly injectable buprenorphine safe, effective in pregnancy and postpartum

March 18, 2026

This randomized, open-label, noninferiority trial (NCT03918850) of 140 pregnant adults with opioid use disorder found that weekly extended-release buprenorphine achieved significantly higher illicit opioid abstinence during pregnancy compared with sublingual buprenorphine (82.5% vs. 72.6%, P = 0.009). Postpartum abstinence rates declined and were similar between groups. Extended-release recipients experienced fewer serious adverse events during pregnancy (8.7% vs. 26.8%, P = 0.007) and postpartum (6.0% vs. 18.6%, P = 0.04). Infant outcomes were similar between groups, with no differences in rates or duration of opioid treatment for neonatal opioid withdrawal syndrome, although neonates exposed to extended‑release buprenorphine had slightly larger head circumferences at birth.

Clinical takeaway: Consider weekly extended-release buprenorphine as a viable, evidence-based alternative to sublingual buprenorphine for pregnant and postpartum patients, particularly when adherence, diversion, or daily dosing are concerns.

Source:

Winhusen TJ, et al. (2026, March 16). JAMA Intern Med. Extended-Release vs Sublingual Buprenorphine in Pregnancy Through 12 Months Post Partum: A Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/41837971/