OB/GYN

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

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:

Tools and Strategies To Improve Outcomes For Perinatal Opioid Use Disorder 

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

Moving Beyond the Barriers of Treating Opioid Use Disorder - OB/GYN Focus

Tuesday, July 20, 2021

5:30 pm - 8:30 pm ET

This OB/GYN focused course is made available in part through grant funding from the CDC and in partnership with ACOG. Click here to learn more about the ASAM-ACOG partnership and offerings.

Overview

Challenges Treating OUD? This course provides a deeper dive into implementing office-based treatment for opioid use disorder for pregnant/breastfeeding women.

This case-based, interactive and engaging virtual-live course addresses moving beyond common barriers that prevent clinicians from successfully implementing office-based opioid treatment and provides strategies to overcome them.

Who Should Attend

Healthcare providers who have not yet implemented their waiver or providers who face barriers to implementing their waiver.

Learning Objectives

  1. Recognize common barriers and challenges to implementing treatment of OUD.
  2. Apply evidence-based practices to overcome obstacles to treatment of OUD.
  3. Identify strategies to meet patient care needs with available resources to ensure continuity of care.

Speakers

    • Alta DeRoo, MD, FASAM, FACOG
      Dr. Alta DeRoo has been an attending physician at Naval Medical Center San Diego, Walter Reed National Military Medical Center, Naval Hospital Camp Lejeune, and University of Virginia School of Medicine. She is currently the director of OBGYN at University of Virginia – Culpeper and an associate professor at the University of Virginia School of Medicine. Dr. DeRoo is board certified by the American Board of Addiction Medicine (ABAM), as well as by the American Board of Obstetrics and Gynecology. She is a contributor to publications regarding opioid use disorders among pregnant women and lectures frequently on addiction medicine topics.Dr. DeRoo specializes in treating pregnant women with opioid use disorders and leads an Office Based Opioid Treatment program (OBOT) in Culpeper, VA. She is the regional clinical champion for the education of physicians regarding buprenorphine waiver training for the state of Virginia. She is also the secretary for the Virginia Chapter of the American Society of Addiction Medicine.
    • Kirk Moberg, MD, PhD, DFASAM, FACP, FACPE, CPE
      Dr. Kirk Moberg is a graduate of and Clinical Professor of Internal Medicine and Psychiatry at the University of Illinois College of Medicine. Trained in Internal Medicine he practiced in the field of Addiction Medicine for over 25 years and served as medical director of three addiction treatment centers. He is certified by both the American Board of Internal Medicine and the American Board of Preventive Medicine-Addiction Medicine and is certified as a Medical Review Officer.
    • Tricia Wright, MD, MS, FACOG, DFASAM
      Tricia Wright, MD MS is a Professor of Clinical Medicine in the Department of Obstetrics, Gynecology and Reproductive Health at the University of California, San Francisco. Previously she was at the University of Hawaii and founded the Path Clinic, a perinatal clinic specializing in the care of pregnant and parenting women with Substance Use Disorders. She is board certified in both Obstetrics and Gynecology and Addiction Medicine and a Fellow of the American College of Obstetrics and Gynecology and a Distinguished Fellow of the American Society of Addiction Medicine. She has published multiple papers on pregnancy and addiction as well as a textbook Opioid Use Disorders in Pregnancy published in 2018 by Cambridge University Press.Dr. Wright completed her undergraduate degree in Biological Sciences from Stanford University, her MD from the University of Michigan. She completed her residency in Obstetrics and Gynecology from the University of New Mexico and obtained a Master’s Degree in Clinical Research from the University of Hawai‘i.

 

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.