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Perinatal SUD Education Series

Perinatal OUD Continuity & Retention

Pregnancy Through 12 Months Postpartum

Clinical Pathway for Sustained Treatment Engagement

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Epidemiology

The Postpartum Overdose Crisis

6.9 → 12.2

Overdose deaths per 100,000 births
(2018-2021)

75%

Maternal drug-related deaths
occur postpartum

Critical Window: The 7-12 month postpartum period represents peak overdose risk. Loss of physiologic tolerance + treatment gaps = lethal vulnerability.

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Evidence

MOUD Retention Data

Timing of MOUD Initiation	12-Month Continuation Rate
Throughout pregnancy	80%
Final month before delivery	34%
Overall average	64.1%

Key Finding: Earlier MOUD initiation during pregnancy dramatically predicts postpartum retention. Every trimester of exposure to treatment matters.

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Systems Gap

Handoff Failure Points

Transition	Failure Mechanism	Consequence
Prenatal → L&D	MOUD dose not communicated	Undertreated pain
L&D → Postpartum	Inconsistent MOUD orders	Missed doses
Hospital → Home (0-14d)	No warm handoff	Highest loss to follow-up
6 Weeks → 6 Months	Medicaid ends at 60 days	Insurance loss

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Interventions

Care Model Comparison

Model	Retention Evidence	Best For
Integrated OB-Addiction	69% at 6 months	Stable housing, outpatient
Low-Threshold Bridge	Doubles treatment entry	Rapid engagement
Tele-MOUD	48% vs 44% 90-day retention	Rural, transportation barriers
Peer Recovery Support	Nearly doubles MOUD acceptance	Trust-building, engagement

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Policy Impact

Policy Environment Effects

Punitive Policies

Criminalization of substance use in pregnancy
43% higher odds of no planned MOUD
45% increase in opioid overdoses

Supportive Policies

Treatment funding, Medicaid extension
+11% MOUD receipt
-45% opioid overdoses

      12-Month Medicaid Extension: Increases MOUD months by 8.55%, continuation beyond 60 days by 5.12%.
    

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Protocol

Warm Handoff Bundle

At Discharge (Critical 72-Hour Window)

✓ Schedule next MOUD appointment within 7 days
✓ Direct communication to outpatient MOUD provider
✓ Naloxone first-aid kit provided (≥2 doses)
✓ 1-2 week medication supply secured
✓ Plan of Safe Care completed collaboratively
✓ Peer recovery specialist contact within 48 hours

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Care Coordination

Postpartum Follow-Up Schedule

Visit	Timing	Core Elements
1	7–14 days PP	MOUD check, mood, feeding, naloxone, safety
2	6 weeks PP	MOUD, contraception, PHQ-9, Edinburgh, PCL-5
3	3 months PP	MOUD retention, mental health, SDOH
Ongoing	Monthly	Peer navigator outreach; coordinate with pediatric visits

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Health Equity

Equity Stratification

Dimension	Disparity	Intervention
Race/Ethnicity	Black women: 31% MOUD vs 57% White	Standardized protocols; cultural competency
Insurance	28.7% coverage disruption postpartum	12-month Medicaid extension
Rurality	Fewer buprenorphine prescribers	Tele-MOUD; mobile units

Retention Disparity: Non-White women: 0.51 probability vs White women: 0.65 at 12 months.

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Quality Improvement

QI-Ready Metrics

Process Measures

MOUD initiation within 7 days: ≥80%
Postpartum follow-up ≤14 days: ≥75%
Naloxone provision: ≥90%
Warm handoff documented: ≥85%

Outcome Measures

MOUD continuation 6 weeks: ≥75%
MOUD continuation 6 months: ≥65%
MOUD continuation 12 months: ≥45%
Overdose events: Trending ↓

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Summary

Key Messages

The postpartum period is the highest-risk window. 75% of maternal drug-related deaths occur after delivery.
Earlier MOUD initiation = better retention. Full pregnancy exposure: 80% continuation vs 34% for late initiators.
Warm handoffs prevent gaps. Every transition requires direct communication and scheduled follow-up.
Policy matters. Medicaid extension, telehealth flexibility, and non-punitive approaches save lives.
Equity requires intention. Standardized protocols reduce racial disparities in treatment access.

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Conclusion

Thank You

Questions?

See companion Speaker Notes and Deep Dive materials for case vignettes.