OB/GYN

OB/GYNs: Addiction Treatment Tools, Training, and Resources

Addiction is a treatable chronic illness and people with substance use disorders and/or risky substance use benefit from access to information and care. Treating persons with addiction is extremely rewarding – the patients are able to do amazing things with their lives and are thankful for receiving kind, compassionate care.Cara Poland, MD, MEd, DFASAM – OB/GYN

Behavioral health in general and addiction in particular intersects with reproductive health in a multiplicity of ways. If we are truly committed to providing comprehensive and holistic care to our patients, we need our care to be inclusive of substance use, misuse and addiction. Mishka Terplan, MD, MPH, FACOG, DFASAM – OB/GYN

Why screen for addiction at an OB/GYN appointment?

In a survey of over 1 million pregnant women, 21.6% filled a prescription for an opioid, and 2.5% received more than a one-month supply.¹ In a study of treatment admissions for prescription OUD, the proportion of pregnant women increased by 26% over 10 years.² NSDUH data show that pregnant women engaging in alcohol and/or tobacco use were more likely to have experienced a past-year major depressive episode.³

According to the CDC, about 7% of women report using prescription opioid pain relievers during pregnancy. Of those women, 1 in 5 reported misusing them. Opioid exposure during pregnancy has been linked to some adverse health effects for both mothers and their babies. Know the signs and know how to treat.

Treatment Resources

Upcoming Live Training Opportunities

On-Demand Training

Treatment Resources:

NIDAMED – Discipline Highlight: OB/GYNs

Review practice guidance, recent substance use and addiction education courses, and other resources just for OB/GYNs.

https://www.drugabuse.gov/nidamed-medical-health-professionals/discipline-specific-resources/discipline-spotlight-obgyns

Opioids, Pregnancy and Neonatal Care: Resources for clinicians to help you treat pregnant women and mothers with opioid use disorder and their infants.

https://www.drugabuse.gov/nidamed-medical-health-professionals/opioid-crisis-pain-management/opioids-pregnancy-neonatal-care

2020 Focused Update of the National Practice Guideline for the Treatment of Opioid Use Disorder

The ASAM National Practice Guideline 2020 focused update is intended to inform and empower clinicians, health system administrators, criminal justice system administrators, and policymakers who are interested in implementing evidence-based practices to improve outcomes for individuals with OUD. This is especially critical in the context of the ongoing COVID-19 emergency, which threatens to curtail patient access to evidence-based treatment.

https://www.asam.org/Quality-Science/quality/2020-national-practice-guideline

Treating Pregnant People with Opioid Use Disorder During COVID-19 Pandemic.

A guide for addiction treatment clinicians and programs working to treat patients with substance use disorders safely and effectively during the COVID-19 pandemic.

https://www.asam.org/Quality-Science/covid-19-coronavirus/treating-pregnant-people-with-oud

ASAM/ACOG Joint Opinion on Opioid Use and OUD in Pregnancy

Opioid use in pregnancy has escalated dramatically in recent years, paralleling the epidemic observed in the general population. To combat the opioid epidemic, all health care providers need to take an active role. Pregnancy provides an important opportunity to identify and treat women with substance use disorders.

https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2017/07/25/opioid-use-and-opioid-use-disorder-in-pregnancy-a-joint-opinion-of-the-american-college-of-obstetricians-and-gynecologists'-committee-on-obsentric-practice-and-the-american-society-of-addiction-medicine

Substance Use, Misuse, and Use Disorders During and Following Pregnancy, with an Emphasis on Opioids

The American Society of Addiction Medicine (ASAM) is deeply committed to the health and well-being of mothers and children. This includes advocating for prevention and treatment of substance-related harm throughout a woman's reproductive years, with a particular focus on addiction and substance use during and following pregnancy.

https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2017/01/19/substance-use-misuse-and-use-disorders-during-and-following-pregnancy-with-an-emphasis-on-opioids

Upcoming Live Training Opportunities:

This ASAM Treatment of Opioid Use Disorder Course, with an Ob-Gyn focus, covers all medications and treatments for opioid use disorder, and provides the required education needed to obtain the waiver to prescribe buprenorphine. The curriculum for this course has been specifically designed for women's healthcare providers and is offered in collaboration with ACOG.

Target Audience: Physicians, Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and Clinical Nurse Specialists who wish to obtain a waiver to prescribe buprenorphine in an office-based setting for opioid use disorder are encouraged to attend. Clinicians and healthcare team members working with waivered providers who treat opioid use disorder are also encouraged to attend.

https://www.asam.org/education/live-online-cme/waiver-qualifying-training/ob-gyn-focus

On-Demand Training Opportunities:

Compassionate Care for Neonatal Abstinence Syndrome: Research, Practice and Public Health

Neonatal Abstinence Syndrome (NAS) secondary to in-utero exposure has increased 5-fold in the US. Providing clinical recommendations, developing safe guidelines to improve care for women with opioid use disorders and their neonates is gaining in priority for programming, policy and research. The panel will discuss NAS through the lens of neonatal and long-term development. Public health and research perspectives will be condensed, with the aim to translate data into a practical clinical guide. The panel will explore compassionate ways to normalize postpartum care while supporting the mom/baby/family triad and the community.

https://elearning.asam.org/products/compassionate-care-for-neonatal-abstinence-syndrome-research-practice-and-public-health#tab-product_tab_overview

The ASAM National Practice Guideline 2020 Focused Update – Pregnant Women

This session follows the ASAM National Practice Guideline 2020 Focused Update Fundamentals session, which outlines the new and updated recommendations in the 2020 Focused Update of the National Practice Guideline for the Treatment of Opioid Use Disorder.

Many of the risks associated with opioid use disorder are similar for both pregnant and non-pregnant women. However, opioid use disorder carries additional risks for pregnant women and prenatal risk for the developing fetus. Treatment of pregnant women with MOUD is associated with substantial improvement in outcomes for both mother and child. This session will provide an overview of the new and updated recommendations and in-depth information on treating pregnant women from the ASAM NPG.

https://elearning.asam.org/products/the-asam-national-practice-guideline-2020-focused-update-pregnant-women

ⁱ Desai RJ, Hernandez-Diaz S, Bateman BT, Huybrechts KF. Increase in prescription opioid use during pregnancy among Medicaid-enrolled women. Obstet Gynecol. 2014;123(5):997-1002

ⁱⁱ Martin CE, Longinaker N, Terplan M. Recent trends in treatment admissions for prescription opioid abuse during pregnancy. J Subst Abuse Treat. 2015;48(1):37-42.

ⁱⁱⁱ Oh S, Reingle Gonzalez JM, Salas-Wright CP, Vaughn MG, DiNitto DM. Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014. Prev Med. 2017;97:93-99.

ⁱᵛ Ko JY, D’Angelo DV, Haight SC, et al. Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy — 34 U.S. Jurisdictions, 2019. MMWR Morb Mortal Wkly Rep 2020;69:897–903.