Opioids

The prevalence of opioid use disorder in the United States continues to rise and is a public health crisis. Because of this, it is increasingly important that providers are educated on opioid prescribing and that patients have access to accurate information and appropriate treatment.

Here are some key resources to help providers and patients, including pregnant women, together carefully weigh the risks and benefits when making decisions to initiate opioid treatment:

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Resources for Providers
Resources for Women and Families
Advocacy Overview and Resources
ACOG Opioid and Addiction Medicine Expert Work Group
Other Resources

Resources for Providers

Opioid Use and Opioid Use Disorder in Pregnancy (Committee Opinion No. 711, August 2017)

Practice Advisory: FDA Boxed Warning on Immediate-Release Opioid Medications and All Prescription Opioids (March 2016)

Opioid Use, Dependency, and Addiction in Pregnancy (Committee Opinion No. 524, May 2012, Reaffirmed 2014)

Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice (Committee Opinion No. 633, June 2015)

Substance Abuse Reporting and Pregnancy: The Role of the Obstetrician-Gynecologist (Committee Opinion No. 473, January 2011, Reaffirmed 2014)

Guidelines for Perinatal Care, 7th Edition (2012, page 127-130)

Nonmedical Use of Prescription Drugs (Committee Opinion No. 538, October 2012, Reaffirmed 2014)

Viral Hepatitis in Pregnancy (Practice Bulletin No. 86, October 2007, Reaffirmed 2016)

Resources for Women and Families

Important Information About Opioid Use Disorder and Pregnancy (PFS012, June 2016)

Tobacco, Alcohol, Drugs, and Pregnancy (FAQ 170, December 2013)

Childbirth, Breastfeeding and Infant Care: Methadone and Buprenorphine (ASAM Pamphlet)

Pregnancy: Methadone and Buprenorphine (ASAM Pamphlet)

Protecting Yourself Against Hepatitis B and Hepatitis C (AP125, October 2016)

Hepatitis B and Hepatitis C in Pregnancy (AP093, November 2013)

Advocacy Overview and Resources

In ACOG’s 2016 Legislative Priorities, ACOG has committed to supporting appropriate efforts to reduce maternal opioid dependence by:

  • Promoting public health efforts to reduce maternal opioid dependence and neonatal abstinence syndrome (NAS).

  • Opposing punitive legislation against women with opioid use disorders and babies born with NAS.

ACOG is committed to leading national efforts to develop and disseminate evidence-based recommendations on opioids. This includes strengthening partnerships with policy makers, federal agencies, and peer organizations to support regulations and clinical recommendations that are evidence-based, increase access to appropriate treatment, and improve outcomes for women. This includes participation in:

ACOG Opioid and Addiction Medicine Expert Work Group

In November 2015, ACOG founded the Opioid and Addiction Medicine Expert Work Group (OAMEWG) to assist ACOG in its opioid-related efforts. This includes guiding and representing ACOG in national committees and other advocacy opportunities. It also includes developing and reviewing clinical guidance, patient education materials, clinical training materials, clinical comments, and other educational tools for providers and patients at all levels of the community. The OAMEWG is comprised of noted obstetrician-gynecologists with expertise and experience in opioid use and addiction, use of drugs in pregnancy, substance use and evidence-based medicine.

Other Resources

A Collaborative Approach to the Treatment of Pregnant Women with Opioid Use Disorders: Practice and Policy Considerations for Child Welfare and Collaborating Service Providers (SAMHSA, ACF) provides best practices for states, tribes, and local communities in addressing the needs of pregnant women with opioid use disorders and their infants and families.

A Public Health Response to Opioid Use in Pregnancy Policy Statement (American Academy of Pediatrics) issues recommendations for a public health response, rather than a punitive approach, to the opioid epidemic and substance use during pregnancy. ACOG supported, December 2016.

American Academy of Addiction Medicine’s Public Policy Statement on the Use of Naloxone for the Prevention of Opioid Overdose Deaths outlines ASAM’s recommendations.

CDC Guideline for Prescribing Opioids for Chronic Pain provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care. CDC offers clinical tools to support providers, as well as a corresponding Opioid Guideline Mobile App that helps providers apply the recommendations of the guideline into clinical practice. It includes the entire guideline, tools, and resources.

Hepatitis C Virus Infection Among Women Giving Birth — Tennessee and United States, 2009–2014 is an MMWR published in 2017, in which researchers used U.S. birth certificate data to analyze trends and geographic variations in rates of HCV infection among women giving birth during 2009–2014.

myTopCare is a website dedicated to practicing physicians, pharmacists and other clinical professionals who care for patients with chronic pain using opioid medications.

National Institute on Drug Abuse offers a quick screen for drug abuse, a research report on heroin, and a number of other resources on opioids

National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use (ASAM) and a corresponding Promotional Toolkit.

Prescription Drug Monitoring Program Training and Technical Assistance Center at Brandeis University compiles informational profiles for each state’s PDMP.

Project Nurture: Two Approaches to Integrating Perinatal Care with Substance Use Treatment is a resource from the Institute for Healthcare Improvement designed to help providers integrate substance use management into their practice.

Providers’ Clinical Support System for Medication Assisted Treatment is a national training and mentoring project that aims to make available the most effective medication-assisted treatments to serve patients in a variety of settings.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. 

Substance Abuse and Mental Health Services Administration (SAMHSA) offers numerous resources on medication-assisted treatment. Their Buprenorphine Treatment Physician Locator is an interactive map that helps providers and patients find physicians who are authorized to treat opioid dependency with buprenorphine by state. MATx Mobile App is free app that supports practitioners in providing medication-assisted treatment for opioid use disorder. It includes a guide for becoming certified to prescribe buprenorphine, information on medications, clinical support tools, and access to critical helplines and SAMHSA’s treatment locators. 

State Policies on Substance Abuse During Pregnancy (Guttmacher Institute) offers a summary of state laws regarding substance abuse, reporting, testing, and treatment.

University of California, San Francisco, Clinician Consultation Center offers peer-to-peer consultation from physicians, clinical pharmacists, and nurses with special expertise in substance use evaluation and management, including opioid use disorder.

The CRAFFT Screening Tool consists of a series of six questions developed to screen adolescents for high risk alcohol and other drug use disorders.