Opioid Use Disorders and Medication-Assisted Treatment in Pregnancy

young woman sitting with hands clasped talking to a counselorThe rate of opioid misuse and dependence is escalating in many communities, including amongst pregnant and parenting women. In addition, substance use treatment systems are reporting increases in the number of individuals seeking treatment for opioid use disorders. Child welfare systems are reporting increases in caseloads, primarily among infants and young children coming into care and hospitals are reporting increases of infants born with neonatal abstinence syndrome. A coordinated, multi-systemic approach that is grounded in early identification and intervention can assist child welfare and treatment systems in conducting both a comprehensive assessment and ensuring access to the range of services needed by families. Collaborative planning and implementation of services are yielding promising results in communities across the country.

Contact us at ncsacw@cffutures.org or 1(866) 493-2758 to learn more about expanding collaboration and linkages across systems to enhance the capacity of states and local jurisdictions to address the opioid epidemic and improve the safety, health, and well-being of children and their families.

Policy and Practice Resources

Related Webinars

  • NCSACW Webinar Series on Opioid Use Disorders and Treatment
    National Center on Substance Abuse and Child Welfare, 2017

    NCSACW developed a webinar series on medication-assisted treatment for families affected by substance use disorders, opioid use in pregnancy, and treatment for neonatal abstinence syndrome.

State and Local Examples

  • Cover Page
  • Neonatal Abstinence Syndrome: Factors Associated with Neonatal Abstinence Syndrome, Iowa 2013 (PDF 2.63 MB)
    Iowa Department of Human Services and the Iowa Department of Public Health/Bureaus of Family Health and Health Statistics, 2013

    This fact sheet describes neonatal abstinence syndrome among Iowa infants with Medicaid-reimbursed births during 2013 and summarizes recommendations to address risk factors, including tobacco use, among pregnant women with opioid use disorders.
  • Journeys of Hope: Mommies and Babies Overcoming Neonatal Abstinence Syndrome
    Texas Department of State Health Services, 2014

    In this video, three mothers describe their experience in recovering from opioid dependency during pregnancy. Professionals from child welfare, substance use treatment, and the medical field discuss how providing care without judgment results in better outcomes for both mom and baby.
  • Cover Page
  • The Treatment of Opioid Dependence in Pregnancy: Vermont Guidelines (PDF 1.26 MB)
    Vermont Department of Health, Division of Alcohol and Drug Abuse and Fletcher Allen Health, 2010

    This document offers information on types of medication-assisted treatment, guidelines for obstetric providers, and on the management of neonatal abstinence syndrome.
  • Cover Page
  • Neonatal Abstinence Syndrome Clinical Treatment Pathway (PDF 748 KB)
    The State of Queensland (Queensland Health), 2013

    This resource provides clinical steps in identifying and treating infants with neonatal abstinence syndrome as well as a decision tree and tools to document the completion of appropriate clinical steps, including any variations.

Additional Resources

Treatment of Opioid Use Disorders in Pregnancy—Policy and Practice Resources

  • Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy
    The American College of Obstetricians and Gynecologists, and American Society of Addiction Medication, 2017

    Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. It is the committee’s opinion that the current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should be considered.
  • Prenatal Drug Use and Newborn Health, Federal Efforts Need Better Planning and Coordination
    U.S. Government Accountability Office (GAO), February 2015

    GAO examined federal agency efforts related to prenatal opioid use and neonatal abstinence syndrome to identify gaps and determine how federal efforts are planned and coordinated. The report recommends that the U.S. Department of Health and Human Services (HHS) designate a focal point to lead departmental planning and coordination on the issues. The Office of National Drug Control Policy and HHS concurred with the GAO recommendations.

Neonatal Abstinence Syndrome Resources

  • Neonatal Abstinence Syndrome Fact Sheet
    National Association of State Alcohol and Drug Abuse Directors, 2015

    This resource offers an overview and symptoms of neonatal abstinence syndrome (NAS), promising practices, and grant initiatives that address serving infants with NAS and their families.
  • Neonatal Abstinence Syndrome (NAS)
    University of Maryland Medical Center, 2014

    This video explains the basics of NAS, its symptoms, screening/identification, and treatment, including a mother’s experience in having a baby born with NAS.

Essential Information About the Treatment of Opioid Use Disorders

  • Cover Page
  • Can the Science of Addiction Help Reduce Stigma? (PDF 5.68 MB)
    NAADAC, Association for Addiction Professionals, 2015

    This document describes advances made in the treatment of opioid and other substance use disorders based on an increased understanding of addiction as a brain disease. National Institute on Drug Abuse Director Nora D. Volkow, M.D., discusses medication-assisted treatment as critical to addressing the opioid epidemic.
  • Cover Page
  • Knowledge Application Program for Physicians—Based on TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction (PDF 337)
    Substance Abuse and Mental Health Services Administration, 2007

    Practice guidelines help physicians make decisions about using buprenorphine to treat opioid addiction. The document includes information on patient assessment, protocols for opioid withdrawal, and the treatment of pregnant women, teens, and polysubstance users.
  • TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders
    Substance Abuse and Mental Health Services Administration, 2012

    This Treatment Improvement Protocol equips clinicians with practical guidance and tools for treating chronic pain in adults with a history of substance abuse. The TIP discusses chronic pain management, including treatment with opioids, and offers information about substance abuse assessments and referrals.
  • Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT)
    Providers’ Clinical Support System, 2017

    This national training and mentoring project was developed in response to the prescription opioid misuse epidemic and the availability of newer pharmacotherapies to address opioid use disorders. The goal of PCSS-MAT is to make available the most effective medication-assisted treatments to serve patients in a variety of settings, including primary care, psychiatric care, and pain management.
  • Providers’ Clinical Support System for Opioid Therapies (PCSS-O)
    Providers’ Clinical Support System, 2017

    This national training and mentoring project was developed in response to the prescription opioid misuse epidemic and the availability of newer pharmacotherapies to address opioid use disorders. PCSS-O makes available programs on the safe and effective use of opioids for treatment of chronic pain and safe and effective treatment of opioid use disorder.
  • Cover Page
  • Medication-Assisted Treatment for Opioid Addiction: Facts for Families and Friends
    Substance Abuse and Mental Health Services Administration, 2011 (Revised)

    This publication gives families and friends information about medication-assisted treatment for opioid addiction. It describes prescribed opioid medications, their proper use, side effects, withdrawal symptoms, and how medications fit with counseling in the recovery process.
  • Methadone: Removing the Stigma
    Toronto Harm Reduction Task Force and Evidence Exchange Network, 2013

    This video aims to illustrate that methadone is a valid treatment for opiate addiction and provides information about outcomes related to methadone maintenance treatment when paired with supportive services.

Access to Medication-Assisted Treatment

  • Advancing Access to Addiction MedicationsAdvancing Access to Addiction Medications (PDF 4.84 MB)
    American Society of Addiction Medication (ASAM), 2013

    Medicaid coverage and use limitations differ from state to state, resulting in challenges in accessing Medicaid coverage in some areas. ASAM conducted a survey of state Medicaid agencies on accessing Medicaid for medication-assisted therapies (MAT). Challenges reported by states in accessing Medicaid for MAT include:
    • Complex authorization and re-authorization processes;
    • Lengthy approval processes;
    • Minimal coverage or reimbursement of counseling services to accompany MAT while also requiring counseling services as a preauthorization requirement and;
    • “Fail first” (or “step therapy)” criteria that require documentation that less costly therapies have proven ineffective
  • Cover Page
  • Federal Guidelines for Opioid Treatment Programs (PDF 682 KB)
    Substance Abuse and Mental Health Services Administration, 2015

    This publication provides updated guidelines for the operation of opioid treatment programs. It covers patient assessment, treatment planning, medication-assisted treatment (methadone and buprenorphine), overdose and relapse prevention, and recovery care.
  • Cover Page
  • Medication-Assisted Treatment in Drug Courts: Recommended Strategies (PDF 1.17 MB)
    Legal Action Center, 2015

    This report contains three profiles of drug courts with effective medication-assisted therapies (MAT) programs, providing lessons and best practices on how to successfully incorporate MAT within urban, rural, and suburban drug court programs as well as nine recommendations related to services, collaboration, and assessment and monitoring.
  • Medication Assisted Treatment Course
    National Drug Court Institute and American Academy of Addiction Psychiatry, 2012

    This resource provides nine training modules on topics related to substance use disorders, medication-assisted treatment, and legal landscape on like issues.

Related Research Articles

Behnke, M., & Smith, V. C. (2013). Prenatal substance abuse: short- and long-term effects on the exposed fetus. American Academy of Pediatrics, 131(3), e1009-e1024. From http://pediatrics.aappublications.org/content/131/3/e1009 (accessed August 17, 2017).

Chasnoff, I., & Gardner, S. (2015). Neonatal abstinence syndrome: a policy perspective. Journal of Perinatology, 35, 539-541. doi:10.1038/jp.2015.53

Compton, W. M., Jones, C. M., Pharm, D., & Baldwin, G. T. (2016). Relationship between nonmedical prescription-opioid use and heroin use. The New England Journal of Medicine, 374(1), 154-163. doi:10.1056/NEJMra1508490

Gallagher, B. K. (2016). Opioid prescriptions among women of reproductive age enrolled in Medicaid—New York, 2008–2013. MMWR. Morbidity and Mortality Weekly Report, 65.

Hall, E. S., Isemann, B. T., Wexelblatt, S. L., Meinzen-Derr, J., Wiles, J. R., Harvey, S., & Akinbi, H. T. (2016). A cohort comparison of buprenorphine versus methadone treatment for neonatal abstinence syndrome. The Journal of Pediatrics, 170, 39-44. doi:http://dx.doi.org/10.1016/j.jpeds.2015.11.039

Han, B., Compton, W. M., Jones, C. M., & Cai, R. (2015). Nonmedical prescription opioid use and use disorders among adults aged 18 through 64 years in the United States, 2003-2013. Journal of the American Medication Association, 314(14), 1468-1478. doi:10.1001/jama.2015.11859

Jones, H. E., Fischer, G., Heil, S.H., Kaltenbach, K., Martin, P. R., Coyle, M. G.,...& Arria, A. M. (2012). Maternal opioid treatment: Human experimental research (MOTHER)—Approach, issues and lessons learned. Addiction, 107, 28-35. doi:10.1111/j.1360-0443.2012.04036.x

Knopf, A. (2016). Why MAT staff need to communicate with law enforcement and courts. Alcoholism & Drug Abuse Weekly, 28(16), 1-4.

Mircik, R. G., & Steenrod, S. A. (2016). Opioid use disorder, attachment, and parenting: Key concerns for practitioners. Child and Adolescent Social Work Journal, 33(6), 547-557.

Mohlman, M. K., Tanzman, B., Finison, K., Pinette, M., & Jones, C. (2016). Impact of medication-assisted treatment for opioid addiction on Medicaid expenditures and health services utilization rates in Vermont. Journal of Substance Abuse Treatment, 67, 9-14.

Nelson, L. S., Juurlink, D. N., & Perrone, J. (2015). Addressing the opioid epidemic. Journal of the American Medication Association, 314(14), 1453-1454. doi:10.1001/jama.2015.12397

Patrick, S. W., Schumacher, R. E., Benneyworth, B. D., Krans, E. E., McAllister, J. M., & Davis, M. M. (2012). Neonatal abstinence syndrome and associated health care expenditures: United States, 2000–2009. Journal of the American Medical Association, 307(18), 1934-1940. doi:10.1001/jama.2012.3951

Patrick, S. W., Davis, M. M., Lehmann, C. U., & Cooper, W. O. (2015). Increasing incidence and geographic distribution of neonatal abstinence syndrome: United States 2009 to 2012. Journal of Perinatology, 35, 650-655. doi:10.1038/jp.2015.36

Patrick, S. W., & Schiff, D. A. M. (2017). A public health response to opioid use in pregnancy. Pediatrics, 139(3), 1-7. From http://pediatrics.aappublications.org/content/early/2017/02/16/peds.2016-4070 (accessed August 17, 2017).

Saloner, B., & Karthikeyan, S. (2015). Changes in substance abuse treatment use among individuals with opioid use disorders in the United States, 2004-2013. JAMA, 314(14), 1515-7. From https://www.ncbi.nlm.nih.gov/pubmed/26462001 (accessed August 17, 2017).

Tolia, V. N., Patrick, S. W., Bennett, M. M., Murthy, K., Sousa, J., Smith, P.B.,… & Spitzer, A. R. (2015). Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. The New England Journal of Medicine, 372, 2118-2126. doi:10.1056/NEJMsa1500439

Wiles, J. R., Isemann, B., Ward, L. P., Vinks, A. A., & Akinbi, H. (2014). Current management of neonatal abstinence syndrome secondary to intrauterine opioid exposure. The Journal of pediatrics, 165(3), 440.


Highlighted Resource

View All  View All

Back to Top