Treating Addiction As An OB/GYN

When thinking of patients with addiction, often pregnant women or women seeing an OB/Gyn do not come to mind. However, in a survey [1]of over one million pregnant women, 21.6% filled a prescription for an opioid, and 2.5% received more than a one-month supply. In a study of treatment admissions for prescription opioid use disorder (OUD), the proportion of pregnant women increased by 26% over ten years.

Tricia E. Wright, MD,MS, FACOG, DFASAM, professor at the University of California San Francisco highlighted some critical questions regarding treating addiction in the OB/GYN during National Addiction Treatment Week, a week dedicated to raising awareness that addiction is a treatable, chronic disease.

According to SAMHSA, nearly 24 million females ages 18 or older used illicit drugs in 2019. Compared to males with substance use disorder (SUD), females with SUD may experience more functional impairment and higher rates of co-occurring psychiatric disorders. [2]

Dr. Wright explains that medication for treatment of OUD is the standard of care during pregnancy as she said, “Medication has consistently been shown to improve pregnancy outcomes, compliance with prenatal care, decreased risk of contracting infectious diseases, and decreased maternal overdose death.”

Additionally, Dr Wright explained, the choice of medication, methadone or buprenorphine, should be patient centered depending on past experience and availability of medication withing the community. Buprenorphine is associated with much less severe neonatal withdrawal and methadone can be better for women who have not done well on buprenorphine in the past.

As clinicians treat pregnant women with SUD or OUD, monthly surveillance is necessary. “Monthly ultrasounds for growth can be helpful especially if the woman smokes cigarettes and can also improve bonding and compliance with prenatal care,” Dr. Wright says. She also adds “if IUGR found, then biweekly NSTs are recommended.”

It’s important to be compassionate and patient with those you’re treating. “Addiction is a treatable chronic illness and people with 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,” says internal medicine physician Cara Poland, MD, MEd, FACP, DFASAM.

When OB/GYNs and other clinicians use judgmental language to address alcohol during pregnancy, they may alienate their patients. Special care is also needed when discussing alcohol use with patients whose pregnancy experience may be outside of the norm.

In addition, Dr. Wright emphasizes that the effects of neonatal withdrawal can be lessened, recommending that clinicians “encourage smoking cessation, rooming in protocols with eat, sleep, console, and breastfeeding.”

While treating addiction might be seem overwhelming and intimidating, addiction medicine specialists who are OB/GYNs encourage others in the field to treat addiction.

Find more resources on our OB/GYN page of NATW.

[1] 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. Source 2: 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. Source 3: 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.

[2]  Substance Abuse and Mental Health Services Administration. Results from the 2019 National Survey on Drug Use and Health, Detailed Tables: Table 1.23A – Illicit Drug Use in Past Year among Persons Aged 12 or Older, by Age Group and Demographic Characteristics: Numbers in Thousands, 2018 and 2019. https://www.samhsa.gov/data/sites/default/files/reports/rpt29394/NSDUHDetailedTabs2019/NSDUHDetTabsSect1pe2019.htm#tab1-23a. Published 2020. Accessed September 24, 2020. Source 2: McHugh RK, Votaw VR, Sugarman DE, Greenfield SF. Sex and gender differences in substance use disorders. Clin Psychol Rev. 2018;66:12-23. doi:10.1016/j.cpr.2017.10.012