Naloxone Prescribing and Naloxone Administration in Response to Overdose Events Among Women With Opioid Use Disorder During Pregnancy and Postpartum Period - MAT-LINK, Seven Clinical Sites, 2014-2021.

objectivesOpioid use disorder (OUD) and overdose among pregnant and postpartum women pose severe risks to maternal and infant health. Naloxone, a life-saving opioid antagonist, effectively reverses opioid overdoses but remains underutilized in this population. We examined naloxone prescription or receipt and administration during overdose events among perinatal women with OUD from the MATernaL and Infant Clinical NetworK (MAT-LINK).

methodsWe analyzed data collected through 7 MAT-LINK clinical sites from pregnant women with OUD and known pregnancy outcomes between January 1, 2014 and August 31, 2021. Outcomes included naloxone prescriptions and naloxone administration during overdose events during pregnancy or within 12 months postpartum (perinatal period). Weighted prevalence estimates and confidence intervals were calculated by demographic characteristics, substances involved in overdoses, and receipt of medications for opioid use disorder (MOUD).

resultsOnly 3.1% of women received a naloxone prescription during the perinatal period; the percentage of women receiving naloxone from the clinic without a prescription was unknown and not systematically captured in the data. Women experiencing overdose events most commonly were non-Hispanic, white, had public health insurance, and lived in urban areas, reflecting the demographic composition of the MAT-LINK cohort, with high co-occurrence of tobacco/nicotine (80.5%) and stimulant use disorders (59.2%). Among women who experienced an opioid-involved overdose event, 23.4% were not administered naloxone. No significant demographic differences were observed by naloxone administration.

conclusionsThese findings highlight the need for further investigation into barriers and facilitators to naloxone clinical documentation, access, and use during the perinatal period.