U.S Department of Health and Human Services U.S Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
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Treatment for Opioid Dependence During Pregnancy

While there has been a significant concern about the misuse of prescription pain medication and illegal opioids by pregnant women and the number of babies born experiencing Neonatal Abstinence Syndrome (NAS), there is wide divergence of understanding and practices, especially amongst non-medical professionals, for treating and responding to the needs of these women and children. Complicating this matter is that there are many medical and non‐medical professionals potentially impacting treatment decisions for pregnant women with opioid dependence. This includes substance abuse treatment providers, and if referred from or involved in the child welfare system, the child welfare social worker and judicial representatives: the parent’s lawyer, child’s lawyer and the judge. Each professional and the organizations that they represent are responding to directives from their organizations or in the absence of directives, using their professional judgments to make decisions affecting the woman and her child. Child welfare and family court jurisdictions and the organizations, agencies and individual professionals that work with them, are struggling to develop policies and practices in response to prescription drug abuse, illicit opiate use and medication assisted treatment (MAT) for families affected by opioid dependence. These issues may be compounded when infants are affected by NAS.

NCSACW is organizing a national working group to articulate the questions and policy considerations that guide practice for a wide range of professionals working with pregnant women with opioid dependence and their children. The purpose of the Working Group is to study, understand and share what is required to create a supportive, system-wide response to women with opioid dependence during pregnancy and to their infants during the immediate post‐natal period (one year after birth).

Treatment for Opioid Dependence During Pregnancy

Individuals may be undergoing MAT for a variety of issues, including substance use and mental disorders and pain management. Implications of MAT for pregnant women and infants are of critical importance. There is often a lack of understanding on how MAT can be safely and medically managed during pregnancy, as well as the effects of MAT in the post-natal period and how these situations should be handled by child welfare.

ASAM - Advancing Access to Addiction Medications: Implications for Opiod Addiction Treatment (PDF 4,830 KB)
Buprenorphine/naloxone, buprenorphine, methadone and extended-release injectable naltrexone are FDA-approved medications shown to be highly effective in the treatment of opioid addiction, a chronic, life-threatening disease that affects millions of Americans. As with most chronic diseases, opioid addiction often requires long-term medication maintenance to achieve optimal outcomes. This publication provides a series of reports from the American Society of Addiction Medicine and the National Institute of Drug Abuse, which offer an overview of the effectiveness of medications used for treatment of opiod dependence, and the implications for healthcare costs and coverage for medication assisted treatment.

Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a group of problems that occur in a newborn who was exposed to opiods while in the mother’s womb. There is a critical need for guidance and practice examples in developing a coordinated response to NAS between child welfare, substance abuse treatment, MAT providers, family court and medical professionals.

Treatment of Opiod Dependence in Pregnancy (PDF 1190 KB)
The University of Vermont - 2010. These best practice guidelines were written as a collaborative effort between the division of Alcohol and Drug Abuse Programming at the Vermont Department of Health, the Maternal Fetal Medicine Department at Fletcher Allen Health Care and the Neomedical Follow-up Department at Fletcher Allen Health Care. The obstetrical and pediatric guidelines were written for use at our institution after a decade of work with the population of substance dependent pregnant women and their children. They are intended for clinical providers and policy makers to review and use as a template.

Opioid Abuse, Dependence, and Addiction in Pregnancy (PDF 386 KB)
Committee on Health Care for Underserved Women and the American Society of Addiction Medicine - 2012. Opioid use in pregnancy is not uncommon, and the use of illicit opioids during pregnancy is associated with an increased risk of adverse outcomes. It is the Committee’s opinion that the current standard of care for pregnant women with opioid dependence is referral for opioid-assisted therapy with methadone, but emerging evidence suggests that buprenorphine also should also be considered.

Policy and Practice

Drug Testing in Child Welfare: Practice and Policy Considerations (PDF 92 KB)
Substance Abuse and Mental Health Services Administration. 2010 (SMA) 10-4556 This document guides child welfare agency policymakers in developing practice and policy protocols regarding the use of drug testing in child welfare practice. This guidance describes the practice and policy issues that policymakers must address to include drug testing in the comprehensive assessment and monitoring that child welfare agencies provide.

Substance-Exposed Infants: State Reponses to the Problem (PDF 1,150 KB)
Young, N. K., Gardner, S., Otero, C., Dennis, K., Chang, R., Earle, K., & Amatetti, S. Substance Abuse and Mental Health Services Administration, 2009
This study assessed State policy from the broadest perspective: prevention, intervention, identification, and treatment of prenatal substance exposure, including immediate and ongoing services for the infant, the mother, and the family.

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