Supporting Birthing People and Families During COVID; Tools for Buprenorphine and Methadone

The COVID-19 crisis has urged adjustments in care for birthing people with SUD to balance the risks from both addiction and COVID-19. Early identification and timely treatment of substance use disorder (SUD) in pregnancy is a priority for birthing people, families, clinicians and society. COVID-19 has presented uniques opportunities for us to improve care and guidelines on removing barriers to care in the current crisis, with a particular focus on Opioid Use Disorder (OUD). Common goals include prevention of illness progression, education regarding best care practices, and improved access to comprehensive treatment. Provision of compassionate care includes appropriate setting and pharmacotherapy for OUD, as well as safeguards against discrimination and stigmatization. Validation of flexible care model during the COVID crisis and approach through research will help build a stronger evidence base for effective policies and care delivery strategies in the future. As the social and health repercussions of COVID and SUD during pregnancy/postpregnancy grow heavier, necessary interventions along the continuum of prenatal and postpartum care (such as office flexibility and telehealth) are gaining in urgency for programming, policy and research focus. The panel will discuss opioid use disorder treatment during pregnancy and in the postpregnancy period. Evidence-based management approaches for opioid use disorder, pharmacotherapy initiation and clinical setting flexibility during COVID in addition to overdose prevention will be provided. Perinatal, postpartum, family, public health and research perspectives will be condensed, with the aim to translate data into a practical clinical guide. Hendree Jones will present research data on maternal mortality and overdose prevention through a public health lens highlighting fatal and non-fatal postpartum overdose in relationship to COVID and fentanyl crisis; review of evidence-based MOUD practices, SAMHSA and research updates for treating birthing people with OUD will be discussed.Tricia Wright will discuss Methadone initiation, up titration and dosing in pregnancy and beyond, with focus on pharmacokinetics and evidence-based recommendations in the prenatal and postpregnancy care. Jack MacCarthy will discuss MOUD with Methadone, evidence and benefits from standardizing split Methadone dose pharmacotherapy, plasma levels, and provide suggestions for improving postpartum and lifecourse care for people with OUD who continue split Methadone dose.Vania Rudolf and Ngoc Pham will address challenges and practical considerations for co-occurring methamphetamine and opioid use disorder, with focus on in-person/telehealth clinical care, initiating buprenorphine and Methadone-buprenorphine crossover while summarizing treatment benefits to optimize birthing people outcomes during COVID and the life course.