Women and substance use disorder statistics: overdose rates, pregnancy treatment gaps, and medication access

She was 29 weeks pregnant when she told me she had been taking leftover oxycodone from a surgery two years earlier, then buying pills when those ran out. She had stopped cold turkey the week she found out she was pregnant, then started again after three days of withdrawal that she could not hide from her partner. She did not want methadone. She did not want a file that said "opioid use disorder" in it. She wanted to know whether I would report her.

That question is the one I hear most often, and it is the one that most reliably keeps people out of care. The clinical answer is that medications for opioid use disorder (MOUD) are recommended in pregnancy and that abrupt cessation is more dangerous than continuing treatment. The practical answer is that many women still believe, with some reason, that seeking treatment puts custody of their children at risk.

The national numbers make the scale of the problem clear without inventing drama. According to the National Center for Health Statistics, the age-adjusted drug overdose death rate among U.S. females fell from 18.3 per 100,000 in 2023 to 14.1 in 2024. That is a 23.0% drop, the largest annual decrease NCHS recorded for women across the prior decade. Progress is real. The rate is still more than double what it was in 2003.

This article gathers the statistics a reporter or clinician can cite with a primary source attached. Topics include overdose mortality among women, the prescription pathway into opioid use disorder, the treatment gap in pregnancy, stigma and custody fear, and how few women who need medication for OUD actually receive it.

Year	Deaths per 100,000
2014	11.1
2015	11.8
2016	13.4
2017	14.4
2018	13.6
2019	13.7
2020	17.1
2021	19.6
2022	19.4
2023	18.3
2024	14.1

Source: NCHS Data Briefs No. 522 (2003-2023 series) and No. 549 (2023-2024). Age-adjusted rates per 100,000 standard population.

Group	Received MOUD among those treated
Women	39.5%
Men	51.0%
All adults treated for OUD	45.5%
All adults who needed OUD treatment (any MOUD)	25.1%

Source: Dowell et al., CDC MMWR, 2024, analysis of 2022 National Survey on Drug Use and Health.

Overdose deaths among women

Men still die of drug overdose at higher rates than women in every year NCHS has published sex-stratified rates. That fact is sometimes used to wave away women's overdose mortality. It should not be. In 2023, 30,818 women in the United States died of drug overdose, according to NCHS Data Brief No. 522. That is nearly 85 women a day. The age-adjusted rate that year was 18.3 deaths per 100,000 standard population.

The long arc is steep. NCHS tabulated female rates from 6.4 per 100,000 in 2003 to a peak of 19.6 in 2021, a nonsignificant dip to 19.4 in 2022, and a drop to 18.3 in 2023. Data Brief No. 549 then documented the larger 2023-to-2024 decline: from 18.3 to 14.1, a 23.0% fall and the largest single-year percentage decrease for women in the agency's 10-year comparison window. Male rates fell 27.3% that year (from 44.3 to 32.2), so the absolute gap narrowed but did not disappear.

Two caveats sit next to any celebration of that drop. First, 14.1 is still more than twice the 2003 female rate of 6.4. Second, synthetic opioids other than methadone (primarily illicit fentanyl) remain the dominant driver of overdose mortality overall. Between 2023 and 2024, the national rate of overdose deaths involving those synthetic opioids fell 35.6%, from 22.2 to 14.3 per 100,000 for the whole population. Progress is real; it is not a solved problem, and overdose among women is not limited to people with a long history of illicit use.

The prescription pathway

Women are more likely than men to fill an outpatient opioid prescription. That is not a contested finding; it is a durable pattern in national dispensing data. In a CDC MMWR analysis of retail pharmacy records for 2008-2018, 21.9% of adult women filled at least one opioid prescription in 2018, compared with 16.5% of men. Women had approximately 1.5 times the odds of filling a prescription overall. The gap was present in every age group and was largest among adults aged 25-34, where women had nearly twice the odds of men (19.0% versus 10.6%).

Those fills are not, by themselves, opioid use disorder. Most people who take a short course of opioids after a procedure never develop a use disorder. The clinical problem is the subset who continue or transition. Historical research summarized by the National Institute on Drug Abuse found that among people who used heroin, nearly 80% reported prior nonmedical use of prescription opioids. That national-level figure still shapes prevention thinking, even as the illicit market has shifted toward fentanyl.

Why women fill more prescriptions is only partly understood. CDC authors pointed to higher rates of certain chronic pain conditions, higher use of health care, and painful reproductive conditions during childbearing years. None of that is an argument against treating pain. It is an argument for multimodal pain care and follow-up after the first refill.

Pregnancy adds a second layer of exposure. A 2020 CDC Vital Signs report using 2019 survey data from 34 jurisdictions found that 6.6% of women with a recent live birth reported using a prescription opioid pain reliever during pregnancy. Among those who used, 21.2% reported misuse as defined by the survey: a non-health-care-provider source or a reason other than pain. Just over one in four (27.1%) said they wanted or needed to cut down or stop. Nearly one in three (31.9%) said no provider had talked with them about how use could affect an infant. That is a conversation gap in a population already in clinical contact for prenatal care.

Measure	Share
Any self-reported prescription opioid use in pregnancy	6.6%
Misuse among those who used (non-provider source or non-pain reason)	21.2%
Wanted or needed to cut down or stop	27.1%
Received counseling on infant effects	68.1%

Source: Ko et al., CDC Vital Signs / MMWR, 2020 (2019 survey data).

The treatment gap in pregnancy

Opioid use disorder in pregnancy is both under-recognized and undertreated. Those are different problems, and the data measure them differently.

KFF's 2023 analysis of Medicaid claims for 2017 and 2018 births in 39 states found that 2.7% of pregnant or postpartum Medicaid enrollees had clinical documentation of opioid use disorder (about 65,000 people in the analytic sample). That is a claims-based figure, not true prevalence. Stigma, incomplete screening, and reluctance to document a diagnosis that could trigger child-welfare reporting all push the recorded rate down. The true number of perinatal OUD cases is almost certainly higher than billing data show.

Among those with a documented diagnosis, an average of 55% received medication for OUD as part of their care. State variation was extreme: 19% in Kansas, 79% in Maine. Younger enrollees received medication less often than those 26 and older (48% versus more than 55%). In the 24-state subset with race and ethnicity data, White enrollees had documented OUD at 5.5%, compared with 1.1% among Black enrollees and 0.6% among Hispanic enrollees. Receipt of MOUD among those with a documented diagnosis was lower for Black enrollees (31%) than for Hispanic and White enrollees (53%-57%). That is an access and quality gap that is hard to dismiss as preference.

Downstream is neonatal abstinence syndrome (NAS). According to 2020 Healthcare Cost and Utilization Project data cited by CDC, about 6 newborns per 1,000 hospital stays were diagnosed with NAS (roughly one every 24 minutes, or more than 59 newborns a day). The number of babies born with NAS rose 82% from 2010 to 2017, with state rates ranging from about 1 per 1,000 newborn stays in Hawaii to 43 in West Virginia.

MOUD can be associated with neonatal opioid withdrawal. That is expected pharmacology, not a reason to withhold treatment. ACOG and ASAM recommend methadone or buprenorphine for pregnant patients with OUD; CDC states the same standard. Untreated OUD carries higher risks of return to unregulated use, overdose, preterm birth, and pregnancy-associated death. The clinical trade is not "medication versus a drug-free pregnancy." It is stabilized treatment versus chaotic use and interrupted prenatal care.

For related maternal risks, see our reviews of preventable maternal mortality and postpartum depression statistics. Co-occurring mood disorders are common and change both screening and treatment planning.

Stigma, custody fear, and care avoidance

Statistics on treatment gaps are incomplete if they ignore why people stay away. For pregnant and parenting women, the barrier is often distance or insurance. It is also fear of losing custody.

KFF notes that punitive state approaches to substance use in pregnancy (treating prenatal drug use as child abuse or neglect and mandating reports to child welfare) can suppress both diagnosis and treatment. ACOG has opposed criminalization of substance use in pregnancy and argued for treatment-first policy. That consensus has not produced uniform state law. In some jurisdictions, a positive toxicology screen or a documented OUD diagnosis still initiates a child-protective process even when the patient is on recommended MOUD.

That environment creates a rational fear. A woman who has already lost custody, or watched a relative lose custody after seeking care, may conclude that silence is safer. Silence raises overdose risk and disrupts prenatal care. When the legal system treats treatment as evidence of unfitness, fewer people present for treatment.

Stigma inside clinics compounds the legal fear. Patients describe being labeled "drug-seeking" when they request pain control after delivery, or being pressured to taper MOUD too quickly postpartum. Postpartum is a high-risk window for overdose; abrupt disruption of treatment after delivery is the opposite of what the evidence supports. Continuity of MOUD through the postpartum year is standard perinatal substance-use care.

Parenting logistics matter too. Programs that do not accept children, clinics that require daily attendance without childcare, and appointments that conflict with school pickup all function as soft exclusions. These barriers sit alongside patterns we track in women's mental health statistics and intimate partner violence and women's health. Substance use and depression often travel with violence exposure.

Medication for opioid use disorder

Medications for opioid use disorder, primarily buprenorphine and methadone, substantially reduce overdose risk and overall mortality. The failure is not efficacy. The failure is reach.

In 2022, according to the CDC MMWR cascade-of-care analysis of NSDUH data, an estimated 3.7% of U.S. adults (about 9.4 million people) needed OUD treatment. Only 25.1% of those who needed treatment received medications for OUD. Another 30.0% received some form of OUD treatment without medication. Fully 42.7% did not perceive that they needed treatment at all. Among adults who needed treatment and received any treatment, fewer than half (45.5%) received medication. Within that treated group, women were less likely than men to get medication: 39.5% versus 51.0%.

That sex difference is one of the cleanest quotable findings in the current literature. It lines up with practice: women are more often steered toward counseling-only models, face more childcare constraints around opioid treatment program schedules, and encounter clinicians who underestimate OUD severity when the presenting complaint is pain or perinatal care.

SAMHSA's summary of 2024 NSDUH findings offers a related national measure: among 4.8 million people aged 12 or older with a past-year opioid use disorder, 17.0% (about 818,000 people) received MOUD in the past year. Different denominators and years make that figure not identical to the 2022 MMWR cascade, but the direction is the same. Most people with OUD are not on medication.

Pooled 2022-2024 NSDUH data in SAMHSA's short report on females put past-year substance use disorder at an annual average of 19.4 million adult women, or 14.6% of adult females. That is SUD of any kind, not OUD alone, and it includes alcohol. Still, it is a useful scale marker of roughly one in seven adult women under current survey definitions.

Access constraints remain structural. Methadone for OUD is dispensed through certified opioid treatment programs; many counties still have none. Buprenorphine can be prescribed in office-based settings, and the federal X-waiver requirement was eliminated in 2023, but pharmacy stocking, prior authorization, and workforce shortages still slow initiation. For pregnant patients, CDC and ACOG are explicit: methadone and buprenorphine are first-line options.

Insurance continuity after delivery also determines whether MOUD continues. Coverage cliffs at 60 days postpartum used to be routine; extended postpartum Medicaid in many states has narrowed that cliff. Our analysis of postpartum Medicaid coverage matters here because a medication covered at 32 weeks of pregnancy and uncovered at eight weeks postpartum is, practically, interrupted treatment.

What the numbers mean for care

Overdose mortality among women is falling from a high plateau, not from a solved problem. The 2024 female rate of 14.1 per 100,000 is a genuine improvement over 2021-2023 and is not a return to the early 2000s. Prevention that only targets young men will miss a large share of deaths.

Prescription exposure remains gendered. Higher fill rates among women are a prevention opportunity if pain care improves, and a risk if the only tool is a bottle of tablets with no follow-up. Reproductive-age women need counseling about pregnancy and overdose risk whenever opioids are prescribed, including before any use-disorder diagnosis.

Pregnancy is a high-stakes window and a missed treatment opportunity. Documented OUD in Medicaid perinatal claims is 2.7%; MOUD reaches only about half of those with a diagnosis, and far less in some states and for Black enrollees. Every prenatal clinic should have a low-barrier path to buprenorphine or methadone.

Medication gaps for women are not explained by a lack of effective drugs. The 39.5% MOUD rate among women who already received some OUD treatment is a quality metric. Offering medication the same week and continuing it through postpartum care would move that number. Policy that treats perinatal substance use primarily as a child-protection offense will keep suppressing the engagement that protects children.

For patients and families, the next step is ordinary medical care: a clinician who can prescribe or arrange MOUD, prenatal care that does not punish disclosure, and a postpartum plan when risk often rises. Cycle-tracking tools such as our period calculator or ovulation calculator do not treat substance use disorder, but pregnancy timing questions come up often in this population, and contraception access is part of ordinary care for anyone who wants it.

For confidential treatment referral, the SAMHSA National Helpline is available 24/7 at 1-800-662-HELP (4357). It is free, in English and Spanish, and does not require insurance. In an immediate crisis, call or text 988.

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