Loading...
The epidemic of opioid use in the U.S. has not spared women of childbearing age: In the past decade, 30% to 40% of these women and 20% of pregnant Medicaid recipients have filled narcotic prescriptions, and this trend has been associated with a concomitant rise in opiate abuse (both prescription medications and the more readily available heroin). In part because of a shift in the demographic pattern of opiate abusers toward white, middle-class, suburban patients, renewed focus has been brought to the crisis, and some of this attention has come from policymakers. Authors of a special report explore the role of health policy in this epidemic. Key points are as follows:
The criminalization of substance use during pregnancy is counterproductive; providers should be free to screen all pregnant women for substance use disorders without concern for the consequences.
The chronic nature of addiction should not be underestimated; although women may be abstinent during pregnancy, postpartum relapse rates are significant.
While the standard of care during pregnancy remains medication-assisted treatment (MAT), this strategy's efficacy is bolstered by counseling, behavioral therapy, or both.
Access to MAT during pregnancy (whether with methadone or buprenorphine) must increase to meet current and future needs.
Care of neonates prenatally exposed to opioids requires standardization using evidence-based protocols.
Krans EE and Patrick SW.Opioid use disorder in pregnancy: Health policy and practice in the midst of an epidemic. Obstet Gynecol 2016 Jul; 128:4. (http://dx.doi.org/10.1097/AOG.0000000000001446)
Comment
The roots and consequences of the opioid epidemic extend far beyond the edges of the health care system. Women's health clinicians can be important allies and advocates for their patients who have opioid use disorders, with spheres of influence ranging from their clinics to Capitol Hill. Our professional societies should strive to keep providers up to date regarding evidence-based strategies to care for women and families touched by these disorders, while also leveraging clinicians' considerable influence as agents of policy change.