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14 Articles in Volume 18, Issue #9
Assessing Arthralgia in Children
Children, Opioids, and Pain: The Stats & Clinical Guidelines
How to Fit into a New Practice
How to Talk to Your Chronic Pain Patients
How to Treat Opioid Use Disorder in Pregnant Women
Intranasal Ketamine for Acute Pain in Children
Medication Selection for Comorbid Pain Management (Part 3)
MR Neurography: Using Peripheral Nerve Imaging as a Pain Diagnostic
Naloxone in Schools; Buprenorphine Conversions; OUD Management
Opioid Conversion Calculations and Changes
Pes Anserine Tendino-Bursitis as Primary Cause of Knee Pain in Overweight Women
Self-Management of Chronic Pain in Primary Care
The Homebound Adolescent: Managing Chronic Pain Conditions in the Pediatric Population
The Opioid Band-Aid: The State of Pain Pills, Congressional Bills, and Healthcare in the US

How to Treat Opioid Use Disorder in Pregnant Women

Plus: Best practices for monitoring and caring for female patients with chronic pain conditions.
Pages 29-33
Page 3 of 3

Dr. Meschke: The SBIRT (Screening, Brief Intervention, and Referral to Treatment) tool provides an excellent OUD identification and assistance strategy for healthcare providers. First, providers should proactively screen all women of childbearing age for substance use disorders, including OUD. If a concern is identified, the practitioner then initiates a short conversation about SUD or OUD, providing guidance and answering questions. If the patient is a candidate for additional treatment, the practitioner then provides this information. To be effective, this brief but important interaction requires practitioner preparation, intention, and training. Strategies to promote SBIRT program practices include its integration into the electronic medical record, relationships with OUD and SUD referrals, and the identification of a practice champion to manage and encourage adherence to the implementation of SBIRT.22

Data show that women are more likely to have co-occurring mental health and substance use disorders than men,23 and yet, interventions and services have been historically developed and tailored to the concerns of men.24,25 At the same time, women receiving MAT have greater functional impairments, leading to problems with maintaining employment, housing, relationships, and personal care, for example, than men.26 SAMHSA recently issued guidance27 on the types of services that should be included in comprehensive MAT programs for women, including:

  • special groups to address challenges faced by opioid-addicted pregnant women, education and discussion groups on parenting and childcare
  • available treatments for women addicted to opioids, including pharmacotherapies
  • education and discussion groups on parenting and childcare
  • special groups and services for children and other family members
  • couples counseling
  • assistance in locating safe, affordable housing.

PPM: What is your take on SAMHSA’s proposal? What more may be needed?

Dr. Meschke: I respect and support the SAMHSA’s evidence-based recommendations. They emphasize women’s roles as parents and partners and also address the possibility that her partner may also have OUD. However, reproductive health is missing on this list. Based on our cross-sectional study at the University of Tennesse,19 having more knowledge about opioid use and reproductive health presents an opportunity to reduce unplanned pregnancies and, hence, avoid additional stressors that may contribute to relapse.

Specifically, we found that women enrolled in MAT who were not currently using contraception were less likely to know that it was important to avoid pregnancy and that pregnant women should not use painkillers, than women in MAT who were using effective contraception or who had experienced bilateral tubal ligation or surgical sterilization. A more recent SAMHSA document does highlight the importance of post-partum contraception use for women with OUD,12 but contraception is an important topic for all women of childbearing age, regardless of current or recent pregnancy.

- Q&A by Angie Drakulich, PPM Managing Editor

Last updated on: December 3, 2018
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Managing Opioid Use Disorders and Chronic Pain
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