Opioid Use Disorder in Pregnancy

Area of Science:

• Obstetrics and Gynecology
• Addiction Medicine
• Primary Care Medicine

Background:

• Opioid use disorder (OUD) in pregnancy has seen a significant rise over the last decade.
• Limited treatment accessibility, particularly in rural settings, contributes to undertreatment or lack of treatment for pregnant women with OUD.
• Medically supervised detoxification is contraindicated in pregnancy due to risks to the fetus and high maternal relapse rates.

Purpose of the Study:

• To provide essential information and clinical guidance for healthcare providers treating pregnant women with OUD.
• To address the need for increased provider knowledge in opioid-assisted therapy (OAT) for this population.
• To highlight recent regulatory changes enabling broader OAT access.

Main Methods:

• Review of current literature and clinical guidelines on OUD treatment in pregnancy.
• Analysis of recent FDA regulatory updates concerning buprenorphine prescribing.
• Synthesis of practical recommendations for primary care clinicians.

Main Results:

• OUD in pregnancy necessitates specialized management, with OAT being the recommended approach.
• Recent FDA amendments permit specially trained nurse practitioners and physician assistants to offer buprenorphine treatment in primary care.
• Enhanced primary care provider (PCP) education is crucial for effective OUD management in pregnant patients.

Conclusions:

• Opioid-assisted therapy, particularly with buprenorphine, is a viable and recommended treatment for OUD in pregnant individuals.
• Expanding the prescriber base through updated regulations can improve treatment accessibility in primary care settings.
• Comprehensive clinical guidance is needed to support PCPs in managing this complex patient population.