Obstetrician–gynecologists’ practice patterns related to opioid use during pregnancy and postpartum—United States, 2017

Abstract

Objective: To describe obstetrician-gynecologists' practices and attitudes related to opioid use among pregnant and postpartum women. Study Design: A 2017 cross-sectional survey assessed U.S. obstetrician-gynecologists' (n=462; response rate=34%) practices (management) and attitudes (knowledge, preparedness, confidence, barriers, and resources needed) related to opioid use among pregnant and postpartum women. Modified Poisson regression determined adjusted prevalence ratios (aPR) for advising medication assisted therapy (MAT) for pregnant women with opioid use disorder (OUD) by knowledge, confidence, and preparedness. Results: Of respondents, 33% usually or always advised MAT to pregnant women with OUD. Confidence in treating pregnant women who use opioids (aPR: 1.3, 95% CI: 1.0-1.8) and knowledge that substance use services were covered under the Affordable Care Act (aPR: 1.4, 95% CI: 1.1-1.8) were associated with advising MAT. Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:

Obstetrician–gynecologists’ practices and attitudes on substance use screening during pregnancy

“…Low physician confidence in treating pregnant women using opioids may be indicative of a lack of training in addiction medicine and/or knowledge of the benefits of medication assisted treatment for treatment of opioid use disorder. Physicians that more frequently advise medication assisted treatment for opioid use disorder were more likely to be confident in treating pregnant patients using opioids (34). ACOG guidelines advise physicians to be knowledgeable about local resources for substance use treatment and to provide a referral to brief therapy or additional treatment to patients who need additional services (12).…”

“…Given an overwhelming unmet treatment need for women with substance use disorders in the U.S. (36), obstetrician-gynecologists have a role in offering effective treatment, for example by providing behavioral interventions for tobacco cessation (15) and obtaining waivers to prescribe buprenorphine to treat opioid use disorder (12,15). Practice patterns of obstetrician-gynecologists related to opioid use during pregnancy and postpartum are found in a companion analysis (34).…”

Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction

“…medications including buprenorphine, methadone, and naltrexone or basic harm-reducing interventions including motivational interviewing, naloxone coprescription, and anticipatory guidance about the risk of drug relapse, overdose, and death. 26,47,48 The collective lack of knowledge about addiction medicine in our field is likely a contributing factor to low rates of medication for OUD (MOUD) utilization and continuation in the obstetrical population. 49,50 Few medical curricula are teaching the fundamentals of OUD treatment, and even fewer are tailored to teaching obstetrical providers about specific considerations for this population, including dosing considerations, 51e54 recommendations against medication tapering, or discontinuation in pregnancy.…”

“…Problem: obstetrical providers are not screening systematically for substance use, misuse, and addiction Many pregnant and postpartum women do not spontaneously disclose their substance use to their providers, and multiple studies confirm that we are not systematically asking. 22e25 Although providers report that they are screening for drug and alcohol use, 26 only 1 in 5 routinely uses a validated tool. 23,27 In Colorado (2004e2012), only 17% of women who died of an overdose had a documentation of substance use disorder (SUD) in the prenatal records or during hospitalization for delivery.…”

Modernizing Perinatal Substance Use Management

“…Unfortunately, significant barriers to evidence-based care for women with opioid use disorder exist. Approximately one third of women’s health clinicians recommend pharmacotherapy for those with opioid use disorder during pregnancy (Ko et al., 2020), and less than one half of pregnant women with opioid use disorder receive treatment (Gressler et al., 2019). Women in states without opioid use criminalization during pregnancy are more likely to receive accurate diagnosis and effective treatment (Amnesty International, 2017; Gressler et al., 2019).…”