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Despite the identification of various factors associated with overdose events, including social, demographic, psychiatric, and neonatal outcomes, the relative contributions of these factors to peripartum overdose history (or lack thereof) remain unclear. Thus, this study aims to characterize factors associated with lifetime opioid-involved overdose events among currently pregnant individuals receiving buprenorphine (BUP) treatment for OUD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Treatment-seeking pregnant individuals with an estimated gestational age of 6 to 30\u2009weeks were enrolled in a large multisite randomized controlled trial evaluating 2 BUP formulations for OUD. Participant baseline demographic, substance use, and mental health data were collected using validated measures, and random forest modeling identified key factors associated with lifetime opioid overdose events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The 140 pregnant participants (\n                      <jats:italic toggle=\"yes\">M<\/jats:italic>\n                      <jats:sub>age<\/jats:sub>\n                      \u2009=\u200931.2\u2009years, SD\u2009=\u20094.7; 87.1% White) reported an average of 8.7\u2009years (SD\u2009=\u20095.8) of opioid use, with 92.1% endorsing lifetime prescription opioid use and 82.9% reporting heroin use. The average lifetime number of nonfatal opioid overdose events was 4.8 (SD\u2009=\u200912.1); an overdose was reported by 55% of the sample (n\u2009=\u200977). Random forest analysis (area under the receiver operating characteristic curve\u2009=\u20090.797) incorporating sociodemographic, substance use, and mental health characteristics found that the most important factors associated with lifetime overdose events were, in order, lifetime heroin use, trauma exposure, reliance on partners or parents for financial support, depressive symptoms, and lifetime cocaine use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>These findings underscore the critical need to address substance use, co-occurring mental health, and socioeconomic challenges that are associated with previous opioid overdose. Identifying and targeting key modifiable overdose risk factors can inform the development of tailored interventions to improve outcomes for this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342251390075","type":"journal-article","created":{"date-parts":[[2026,1,3]],"date-time":"2026-01-03T04:47:21Z","timestamp":1767415641000},"page":"493-502","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors Associated With Opioid-Involved Overdose: Descriptive Data From a Randomized Controlled Trial Evaluating Extended-Release Buprenorphine for Perinatal Opioid Use Disorder"],"prefix":"10.1177","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8890-0465","authenticated-orcid":false,"given":"Sara M.","family":"Witcraft","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3869-4891","authenticated-orcid":false,"given":"Leah","family":"Holcomb","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingjia","family":"Wei","sequence":"additional","affiliation":[{"name":"Population Health Sciences Department, University of Utah, Salt Lake City, UT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0153-0252","authenticated-orcid":false,"given":"Gerald","family":"Cochran","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John T.","family":"Winhusen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, OH, USA"},{"name":"Center for Addiction Research, College of Medicine, University of Cincinnati, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle R.","family":"Lofwall","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington, KY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter R.","family":"Martin","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Young","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA"},{"name":"Obstetrics and Gynecology, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Spinali","sequence":"additional","affiliation":[{"name":"HOPE Clinic, Department of Obstetrics &amp; Gynecology, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance","family":"Guille","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.09.028"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6731a1"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.4523"},{"key":"e_1_3_3_5_2","unstructured":"Center for Disease Control and Prevention. 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