Opioid Use Disorder in the Perinatal Population: Reviewing Evidence-Based Care Models and Best Practices

Paralleling the opioid epidemic in the general population, the prevalence of opioid use disorder (OUD) during pregnancy has quadrupled from 1999 to 2014 and rates of neonatal abstinence syndrome have grown nearly fivefold since 2000 (Haight et al., 2018; Patrick et al. 2015). Pregnant people with OUD access less prenatal care and are at risk for worse obstetric, maternal, and neonatal outcomes (ACOG, 2017). Medications for opioid use disorder (MOUD), specifically buprenorphine and methadone, are the standard treatment for OUD in pregnancy (Ecker et al., 2019; ACOG, 2017). Yet, nearly half of all pregnant people with OUD do not receive medications and less than one-third are retained in care at 6 months (Krans et al., 2019; Short et al., 2018; Nguemeni Tiako et al., 2021). Barriers to treatment of substance use disorders (SUD) during pregnancy include lack of access, stigma, and unmet social needs (Jessup et al., 2003; Roberts et al., 2011; Stone et al., 2015; Sutter et al., 2017). There is a critical need to improve the care provided to the perinatal population with SUD. This workshop will use a combination of educational techniques focused on adult learning and engagement strategies to prepare and empower addiction, obstetric, and/or primary care providers to incorporate perinatal SUD care into their practice or innovate to improve currently existing practices. This workshop will have an initial rapid-fire informational component with an overview of available evidence on best practice models for treatment of SUD, racial/ethnic disparities in screening, access, and receipt of treatment for SUD, and lessons learned from existing treatment models. We will then conduct an interdisciplinary panel discussion to share lessons learned from our wrap-around, low-threshold perinatal shared medical appointment model in an urban underserved community. The panel will include a licensed clinical therapist, nurse, clinical pharmacist, and family and addiction medicine clinician. The panel will highlight elements of best practice models in our maternal specialty care program at our institution, including use of a group care approach to increase treatment access and provide group-based counseling and peer support, collaboration with community resources (e.g., recovery-focused housing), and inclusion of a multidisciplinary team to address psychosocial needs and provide care coordination services (Ganetsky et al, 2021). Following the panel discussion, participants will be divided into small groups for an exercise in which they will conduct a strengths, weaknesses, opportunities, and threats (SWOT) analysis of their own systems for creating a successful comprehensive perinatal SUD treatment program. We will enlist each participant’s knowledge and experience to collaboratively create an ideal yet realistic model to improve care of this vulnerable population. Throughout the workshop we will use an ‘All Teach, All Learn’ format to engage everyone from experts to new providers.