Opioid Use Disorder and Overdose in the First Year Postpartum: A Rapid Scoping Review and Implications for Future Research

Objective Opioid overdose is a leading cause of maternal mortality, yet limited attention has been given to the consequences of opioid use disorder (OUD) in the year following delivery when most drug-related deaths occur. This article provides an overview of the literature on OUD and overdose in the first year postpartum and provides recommendations to advance maternal opioid research. Approach A rapid scoping review of peer-reviewed research (2010–2021) on OUD and overdose in the year following delivery was conducted in PubMed, PsycINFO, and Web of Science databases. This article discusses existing research, remaining knowledge gaps, and methodological considerations needed. Results Seven studies were included. Medication for OUD (MOUD) was the only identified factor associated with a reduction in overdose rates. Key literature gaps include the role of mental health disorders and co-occurring substance use, as well as interpersonal, social, and environmental contexts that may contribute to postpartum opioid problems and overdose. Conclusion There remains a limited understanding of why women in the first year postpartum are particularly vulnerable to opioid overdose. Recommendations include: (1) identifying subgroups of women with OUD at highest risk for postpartum overdose, (2) assessing opioid use, overdose, and risks throughout the first year postpartum, (3) evaluating the effect of co-occurring physical and mental health conditions and substance use disorders, (4) investigating the social and contextual determinants of opioid use and overdose after delivery, (5) increasing MOUD retention and treatment engagement postpartum, and (6) utilizing rigorous and multidisciplinary research methods to understand and prevent postpartum overdose. Significance What is already known on this subject: Opioid overdose is a leading cause of maternal death within one year of delivery. Factors that increase susceptibility to or protect against opioid problems and overdose after delivery are not well understood. What this study adds: Seven articles were identified in a rapid scoping review of opioid use disorder (OUD) and overdose in the year following delivery. Medication for OUD (MOUD) was the only identified factor associated with a decreased risk of postpartum overdose. Literature gaps include co-morbid conditions, interpersonal factors, and social and environmental contexts that contribute to opioid-related morbidity and mortality after delivery.