Test your knowledge and learn more about Substance Use Disorder (SUD) and pregnancy, parenting, and birth care.
Managing OUD with MOUD is like using insulin for diabetes – it’s not about replacing but effectively controlling the condition with the right treatment. Like Diabetes, OUD is a condition that can be managed with proper care and treatment.
There are three FDA-approved medications for OUD: methadone, buprenorphine, and naltrexone. These medications are essential in the treatment and management of addiction to opioids. Notably, methadone and buprenorphine are the only treatments for OUD associated with up to 50% reduction in opioid overdose and death.1 MOUD treatment has been proven to effective in.2
Consent is key! A pregnant person should always be aware that their urine is being screened for substances and give the okay, just like any other medical procedure. This ensures dignity, autonomy, and trust are respected.3
MOUD options like buprenorphine, methadone, and naltrexone are safe to use for pregnancy and nursing. Stopping MOUD can be dangerous for pregnant persons and babies by increasing return to use and lowering prenatal care engagement.
For pregnant women with an opioid use disorder, opioid agonist pharmacotherapy is the recommended therapy and is preferable to medically supervised withdrawal because withdrawal is associated with high relapse rates, which lead to worse outcomes. Additional research is needed to assess the safety (particularly regarding maternal relapse), efficacy, and long-term outcomes of medically supervised withdrawal.4
Recovery from OUD can happen in many settings – not just residential facilities. Outpatient care and medications like buprenorphine and methadone provide effective, flexible treatment options supported by science. Recovery is a personal process and there is no one-size-fits-all solution.
Addiction requires compulsive behavior and making choices, which newborns can’t do. Babies can experience withdrawal called Neonatal Opioid Withdrawal Syndrome (NOWS) due to exposure in the womb. NOWS can be managed in different ways, including the Eat-Sleep-Console Model. This model focuses on non-pharmacological care first and has been associated with reduced length of hospital stay for newborns, decreased need for medication, and enhanced bonding between parents and their infants.5
Medications like Buprenorphine, Methadone, and Naltrexone are safe for breastfeeding. If there is no other contraindication, a patient on MOUD should be encouraged to breastfeed if they desire.
Buprenorphine is a partial opioid agonist that binds to the mu-opioid receptors in the brain but activates the receptors to a lesser extent than full opioid agonists such as heroin or methadone. This partial activation provides analgesia and relief from withdrawal symptoms and cravings without the full respiratory depressive effects seen with full agonists.
Methadone is a schedule II-controlled medication and is a long-acting full opioid agonist. It reduces cravings and withdrawal symptoms by acting on opioid receptors in the brain. Methadone can only be dispensed through a SAMHSA certified Opioid Treatment Program (OTP).
Extended-release, injectable naltrexone (Vivitrol) is an (FDA) approved opioid antagonist used to treat OUD. It is also available in pill form but that is not approved for OUD. It is not a controlled substance. Naltrexone blocks the effects of opioids, preventing intoxication and physical dependence.
NOWS may be less common with buprenorphine when compared to methadone; however, the best and safest choice for MOUD is the one that is most effective in treating OUD based on the patient’s history and current use. Regardless of the type of medication used, dose is NOT correlated with NOWS. Personalized treatment that supports recovery is key to ensuring safety for mom and baby.
Fear is the top barrier to prenatal care for birthing people with OUD. Fear of judgment, stigma, shame, withdrawal, and legal consequences can be major barriers to seeking care. Addiction is a chronic condition that can be managed with comprehensive care models, community outreach, and trauma informed approaches.
Stigma can be categorized into several types: public stigma, clinical stigma, internal stigma, and stigma within the recovery community.6 Public stigma refers to the negative attitudes and perceptions held by society at large, often fueled by stereotypes and misinformation. Clinical stigma is encountered within healthcare settings, where biases and prejudiced attitudes from medical professionals can hinder effective treatment. Internal stigma occurs when individuals internalize these societal prejudices, leading to feelings of shame and worthlessness. Lastly, even within the recovery community, stigma can persist, manifesting as judgment or lack of support among peers who are also striving for recovery. Understanding these diverse forms of stigma is crucial for creating more inclusive and supportive environments.
Trauma informed care is a universal approach that can enhance care for all individuals by fostering environments of understanding and respect. It aims to promote healing and recovery through safety, collaboration, trust, empowerment, and cultural, historical, and gender sensitivity.
Over 80% of birthing people with OUD/SUD have experienced trauma or abuse. Trauma informed care is a universal approach that can enhance care for all individuals by fostering environments of understanding and respect. It aims to promote healing and recovery through safety, collaboration, trust, empowerment, and cultural, historical, and gender sensitivity. Every person can benefit from trauma informed care.
The Partnering for the Future (PFF) Clinic at University of Michigan Health Von Voigtlander Women’s Hospital is specifically designed for patients with opioid use disorder (OUD), substance use disorder (SUD) and chronic pain with long-term opioid use. They support patients in every stage from active drug use to recovery. PFF’s interprofessional team provides prenatal care, mental health services, social support and physical therapy and can prescribe medication for OUD for patients who desire this recovery pathway.
