How Doctors Can Help Pregnant Patients with Opioid Use Disorder
Opioid use in pregnancy has escalated dramatically in the last decade, paralleling the epidemic in the general population. Pregnant women suffering from opioid use disorder (OUD) constitute a highly vulnerable patient population. This group experiences a higher risk of unplanned pregnancy, and their infants are at risk for being born with opioid dependence and suffering Neonatal Abstinence Syndrome (NAS).
Pregnant women often face serious barriers to treatment, including legal statutes in some states that support charging women with OUD with criminal child abuse. Twenty-four states and the District of Columbia define substance use during pregnancy as child abuse under civil child-welfare statutes. Twenty-three states and the District of Columbia require healthcare professionals to report suspected prenatal drug use.
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Pregnancy and Opioid Use Disorder: Screening, Intervention and Treatment
The shame attached to opioid use, especially during pregnancy, prevents many women from getting the treatment they need for their own health and that of their infant until they are close to delivery or in labor. Without treatment, these women are at a higher risk of preterm delivery, low infant birth weight and transmitting HIV to their infants.
Pregnancy provides a critical opportunity to identify and treat women with OUD. But what are the correct treatment protocols for medical teams to employ in order to improve outcomes for both mothers and their newborns?
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released guidance that fills an urgent need for reliable, useful and accurate information for healthcare professionals working to treat this population of women.
To combat the alarming rise in women pregnant and addicted to drugs or alcohol, it is imperative to identify those at risk for substance use disorder from preconception and through pregnancy. Validated screening tools, such as the Institute for Health and Recovery’s Integrated 5 P’s outlined below, are useful in identifying patients at risk for prenatal substance use disorder. Maintaining a caring and nonjudgmental manner has been shown to yield the most accurate disclosure. If the pregnant mother feels judged, she is more likely to avoid prenatal care altogether.
In consultation with the patient, ask:
- Parents: Do any of your parents have a problem with alcohol or other drugs?
- Peers: Do any of your friends have a problem with alcohol or any other drug use?
- Partner: Does your partner have a problem with alcohol or drug use?
- Past: In the past, have you had difficulties in your life because of alcohol or other drugs, including prescription medication?
- Present: In the past month, have you consumed any alcohol or used any other drugs?
A “yes” answer to any of the above questions may indicate a need for treatment.
SAMHSA recommends the model of ongoing medication treatment in Treatment Improvement Protocol (TIP) #63, “Medications for Opioid Use Disorders.” The TIP states, “Medication is an effective treatment for opioid addiction. People with opioid addiction should be referred for an assessment for pharmacotherapy unless they decline. Discussing medications that treat opioid addiction with those with this disorder is the clinical standard of care.” This approach should also be extended to all pregnant women.
CleanSlate is a leader in outpatient addiction medicine, with physician-led centers across the country that have treated nearly 30,000 patients. We prioritize pregnant patients because we know that we’re treating not just one life, but two. CleanSlate fast-tracks medication treatment for any pregnant patient and we try our best to see that patient on the day they call or walk into one of our centers.
Read more by downloading our free Pocket Guide:
Pregnancy and Opioid Use Disorder: Screening, Intervention and Treatment
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