Quantcast

Pregnancy and the Opioid Epidemic

Research paper by Kelley Saia, Hendree Jones; Mishka Terplan

Indexed on: 23 Nov '17Published on: 19 Apr '17Published in: Current Treatment Options in Psychiatry



Abstract

Opinion Statement The USA is currently experiencing related epidemics of opioid misuse, use disorder, (over) prescribing, and overdose. We review the current literature on opioid use disorder (OUD) during pregnancy including intrapartum and postpartum considerations, breastfeeding, neonatal abstinence syndrome, and contraception. Screening for OUD in pregnancy should be universal, and pregnant women with opioid use disorder should have access to opioid pharmacotherapy. Pharmacotherapy with opioid agonists, methadone, or buprenorphine remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal is associated with high maternal relapse rates and without demonstrable benefit for mother or newborn. Extended release naltrexone is emerging as treatment option for carefully selected pregnant and postpartum women. Breastfeeding for women stabilized on opioid pharmacotherapy is safe and beneficial for the mother-infant dyad. Enhanced postpartum care for these women should include relapse prevention, recovery support, promotion of breastfeeding to reduce neonatal abstinence syndrome, access to contraception, and synchronized transfer to primary care and addiction medicine specialists.Opinion StatementThe USA is currently experiencing related epidemics of opioid misuse, use disorder, (over) prescribing, and overdose. We review the current literature on opioid use disorder (OUD) during pregnancy including intrapartum and postpartum considerations, breastfeeding, neonatal abstinence syndrome, and contraception. Screening for OUD in pregnancy should be universal, and pregnant women with opioid use disorder should have access to opioid pharmacotherapy. Pharmacotherapy with opioid agonists, methadone, or buprenorphine remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal is associated with high maternal relapse rates and without demonstrable benefit for mother or newborn. Extended release naltrexone is emerging as treatment option for carefully selected pregnant and postpartum women. Breastfeeding for women stabilized on opioid pharmacotherapy is safe and beneficial for the mother-infant dyad. Enhanced postpartum care for these women should include relapse prevention, recovery support, promotion of breastfeeding to reduce neonatal abstinence syndrome, access to contraception, and synchronized transfer to primary care and addiction medicine specialists.