Introduction
OUD, infectious disease, peripartum pain, opioid overdose, HIV, Hepatitis B/C
DISORDER, INFECTIOUS DISEASE, NEONATAL OPIOID WITHDRAWAL, ABUSE
The ongoing epidemic of opioid use in the United States over the past two decades has impacted many individuals. Pregnant individuals are no exception—the rate of deliveries complicated by opioid use disorder (OUD) has quadrupled with a concomitant rise in neonatal opioid withdrawal (NOWS) (In response to the complex issues that pregnant and postpartum individuals (PPI) with OUD experience, the Substance Abuse and Mental Health Services Administration (SAMHSA), American College of Obstetricians and Gynecologists (ACOG), American Society of Addiction Medicine (ASAM), and World Health Organization (WHO) have established recommendations for a comprehensive, collaborative approach to treatment that brings together providers and services from multiple disciplines. Although the intricacies of each set of expert recommendations are beyond the scope of this article, in general the recommendations encompass: 1) Identifying and assessing pregnant individuals with OUD and other SUD by utilizing screening tools, psychosocial assessments, biological toxicology screens; 2) providing MOUD, including naloxone for opioid overdose, rather than opioid withdrawal; 3) providing specialized prenatal care, including physical examination, laboratory testing, imaging, increased pregnancy monitoring; 4) providing a full range of SUD treatment services, including individual and/or group counseling, case management, peer support specialists, mutual support groups, smoking cessation; 5) addressing comorbidities, including testing for infectious disease (HIV, Hepatitis B/C), screening and management of co-occurring medical and behavioral health conditions; 6) providing adequate peripartum pain management; 7) providing ongoing care postpartum, including ongoing treatment for OUD and other SUDs, contraceptive information and access, breast-feeding guidance; 8) providing assessment and care for infants with prenatal exposure to opioids, including management of NOWS, infant developmental assessment, well-baby care; and 9) addressing barriers to receiving services (The NIDA Clinical Trials Network study “Medication treatment for Opioid use disorder in expectant Mothers (MOMs): a pragmatic randomized trial comparing extended-release and daily buprenorphine formulations (CTN0080)” (