Researchers Call for Evidence and Guidelines on Telehealth Buprenorphine for Perinatal Opioid Use Disorder

Investigators have put out a call for targeted research, clinical guidelines, and clearer policy to expand telehealth prescribing of buprenorphine for pregnant and postpartum women with opioid use disorder (OUD). Rachel K. Landis, PhD, MPP, of RAND, et al argue that recent federal and state policy changes have created an unprecedented opportunity to narrow the perinatal OUD treatment gap in a recent JAMA Intern Med Viewpoint.¹

Opioid-related overdose is a leading cause of preventable maternal death. Untreated OUD during pregnancy is associated with increased risk of preterm labor, intrauterine growth restriction, neonatal opioid withdrawal syndrome, and fetal death, and can trigger child welfare involvement or custody loss when identified at delivery.¹

Medications for OUD (MOUD), including buprenorphine, are the criterion standard treatment for perinatal OUD, yet fewer than half of pregnant women with OUD receive them.² Buprenorphine, a partial μ-opioid receptor agonist, eases cravings and withdrawal symptoms with a ceiling effect on respiratory depression, and it can be prescribed and managed remotely. The authors note that telehealth prescribing could address several common barriers to care, including clinician shortages, long wait times, and transportation and child care challenges, and could reach women in rural areas with few local prescribers.

Observational studies show telehealth prescribing of buprenorphine is feasible, acceptable, and clinically comparable with in-person integrated care.³ However, few studies have examined its use among pregnant and postpartum women or the barriers specific to this population.

A Policy Window

The authors point to 2 converging developments. In December 2025, the federal government adopted a permanent policy allowing audio-only telehealth encounters for buprenorphine initiation without an in-person evaluation, building on emergency flexibilities first authorized in March 2020 in response to COVID-19. Audio-only prescribing may help patients who lack reliable internet or cannot afford video-enabled devices, including many in rural areas.¹

In addition, as of March 2026, 49 states and Washington, DC, have expanded postpartum Medicaid coverage from 60 days to 12 months, giving many Medicaid-insured postpartum women with OUD a longer window to receive MOUD.¹

Persistent Barriers

State policies remain fragmented. States differ in whether they allow audio-only encounters for controlled substance prescribing, which types of clinicians may prescribe via telehealth, and whether insurers must reimburse telehealth at rates equivalent to in-person care. Even where parity requirements exist, they do not always extend to Medicaid, which pays for almost 75% of births among women with OUD.^1,4

Medicaid presents further obstacles, according to the authors, including historically lower telehealth reimbursement rates, prior authorization and documentation demands, audit exposure, and, in many programs, coverage of live-video visits only. State approaches to prenatal substance use also matter: in states that treat it punitively, pregnant women may avoid treatment, including telehealth, for fear that a clinician will contact child welfare authorities.¹

At the practice level, elevated malpractice exposure in perinatal care may make clinicians reluctant to treat pregnant patients remotely, and some are willing only to continue, rather than initiate, buprenorphine via telehealth. Pharmacies may hesitate to fill prescriptions from prescribers located far from the patient or pharmacy because of liability concerns and fear of regulatory scrutiny.⁵ Clinicians may also worry telehealth limits rapport building, and no clinical guidelines specifically address telehealth buprenorphine care in pregnancy or post partum. Some patients may lack telephone access or privacy at home.^1,5

A Research Agenda

The authors outline several priorities. These include a comprehensive needs assessment to identify utilization gaps nationally and across states, qualitative interviews with patients and clinicians about real-world barriers, and an up-to-date database of state policies that directly or indirectly affect telehealth buprenorphine prescribing for prenatal and postpartum patients. Researchers should also examine how specific state policy components relate to utilization, they wrote.¹

The authors also call for clear treatment guidelines, which could be developed with professional societies such as the American College of Obstetricians and Gynecologists and the American Society of Addiction Medicine, to address initiation, monitoring, and when in-person evaluation is warranted. Research is needed on integrating telehealth prescribers with obstetric and pediatric care, including referral pathways and ongoing communication about clinical progress. Shared decision-support tools could help clinicians and patients weigh factors such as privacy, co-occurring medical or psychiatric complexity, need for intensive support, work schedules, geographic isolation, and stigma.

"Telehealth prescribing of buprenorphine will not fit every patient or clinical context, but it should be a feasible option for patients and clinicians to discuss together, tailored to clinical circumstances, patient preferences, and the realities of pregnancy and parenting," wrote the authors.¹

The Viewpoint does not report new data; rather, it frames the evidence gap as the central obstacle. "Although telehealth prescribing could expand lifesaving buprenorphine treatment for pregnant and postpartum women, research and policy have not kept pace with this potential benefit," the authors concluded.¹

References

1. Landis RK, Terplan M, Andraka-Christou B, Cantor J. Buprenorphine via telehealth—closing the gap for pregnant and postpartum women with opioid use disorder. JAMA Intern Med. Published online September 21, 2026.

2. Krans EE, Kim JY, James AE III, et al. Medication-assisted treatment utilization among pregnant women with opioid use disorder. Obstet Gynecol. 2019;133(5):943-951.

3. Guille C, McCauley JL, Moreland A. Leveraging telehealth in the United States to increase access to opioid use disorder treatment in pregnancy and postpartum during the COVID-19 pandemic. Am J Psychiatry. 2021;178(4):290-293.

4. Roberts T, Frederiksen B, Saunders H, Salganicoff A. Opioid use disorder and treatment among pregnant and postpartum Medicaid enrollees. KFF. September 2023. Accessed September 30, 2026. https://www.kff.org/medicaid/issue-brief/opioid-use-disorder-and-treatment-among-pregnant-and-postpartum-medicaid-enrollees/

5. Textor L, Ventricelli D, Aronowitz SV. 'Red flags' and 'red tape': telehealth and pharmacy-level barriers to buprenorphine in the United States. Int J Drug Policy. 2022;105:103703.