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Clinical Guidance for Treating Pregnant and Parenting Women

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Clinical Guidance for Treating Pregnant and Parenting Women CLINICAL GUIDANCE FOR TREATING PREGNANT AND PARENTING WOMEN WITH OPIOID USE DISORDER AND THEIR INFANTS Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants ii Acknowledgments This document was prepared for the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), under contract numbers HHSS283200700003I/HHSS28342007T and HHSS283201200002I/HHSS28342009T. LCDR Brandon T. Johnson, MBA, served as the Contracting Officer’s Representative, and Melinda Campopiano, MD, served as the Chief Medical Advisor. Disclaimer The views, opinions, and content expressed herein are the views of the authors and do not necessarily reflect the official position of SAMHSA, other federal agencies or offices, or HHS. Nothing in this document constitutes an indirect or direct endorsement by SAMHSA, other federal agencies or offices, or HHS of any non-federal entity’s products, services, or policies, and any reference to a non-federal entity’s products, services, or policies should not be construed as such. No official support of or endorsement by SAMHSA, other federal agencies or offices, or HHS for the opinions, resources, and medications described is intended to be or should be inferred. The information presented in this document should not be considered medical advice and is not a substitute for individualized patient or client care and treatment decisions. Public Domain Notice All materials appearing in this document except those taken directly from copyrighted sources are in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS. Electronic Access and Copies of Publication This publication may be downloaded from http://store.samhsa.gov. For more information call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Espaol). Recommended Citation Substance Abuse and Mental Health Services Administration. Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants. HHS Publication No. (SMA) 18-5054. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018. Originating Office Division of Pharmacologic Therapies, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD 20857. Nondiscrimination Notice SAMHSA complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. SAMHSA cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. HHS Publication No. (SMA) 18-5054 iii CONTENTS Part A: Introduction ...................................................................................................................................................................................................... 1 Background ................................................................................................................................................................................................................. 2 Epidemiology.............................................................................................................................................................................................................. 2 Barriers to Treatment ............................................................................................................................................................................................. 2 Effective Interventions and Guidelines ......................................................................................................................................................... 3 Definition of Terms...................................................................................................................................................................................................4 Creation of the Guide............................................................................................................................................................................................. 5 RAM Methodology...................................................................................................................................................................................................6 Limitations to the RAM Process and Gaps Identified in the Research........................................................................................6 How To Use the Clinical Guide........................................................................................................................................................................... 7 Introduction Web Resources..............................................................................................................................................................................9 References.................................................................................................................................................................................................................. 10 Part B: Factsheets........................................................................................................................................................................................................13 Section I: Prenatal Care ............................................................................................................................................................................................14 FACTSHEET #1: PRENATAL SCREENINGS AND ASSESSMENTS ................................................................................................17 FACTSHEET #2: INITIATING PHARMACOTHERAPY FOR OPIOID USE DISORDER.........................................................25 FACTSHEET #3: CHANGING PHARMACOTHERAPY DURING PREGNANCY..................................................................... 34 FACTSHEET #4: MANAGING PHARMACOTHERAPY OVER THE COURSE OF PREGNANCY.................................. 39 FACTSHEET #5: PREGNANT WOMEN WITH OPIOID USE DISORDER AND COMORBID BEHAVIORAL ............... HEALTH DISORDERS.......................................................................................................................................................................................... 42 FACTSHEET #6: ADDRESSING POLYSUBSTANCE USE DURING PREGNANCY .............................................................. 45 FACTSHEET #7: PLANNING PRIOR TO LABOR AND DELIVERY...............................................................................................52 FACTSHEET #8: PERIPARTUM PAIN RELIEF ........................................................................................................................................ 58 SECTION I REFERENCES .................................................................................................................................................................................60 iv Section II: Infant Care ...............................................................................................................................................................................................76 FACTSHEET #9: SCREENING AND ASSESSMENT FOR NEONATAL ABSTINENCE SYNDROME ...........................78 FACTSHEET #10: MANAGEMENT OF NEONATAL ABSTINENCE SYNDROME ................................................................. 84 FACTSHEET #11: BREASTFEEDING CONSIDERATIONS FOR INFANTS AT RISK FOR NEONATAL ............................ ABSTINENCE SYNDROME............................................................................................................................................................................... 89 FACTSHEET #12: INFANT DISCHARGE PLANNING........................................................................................................................... 93 FACTSHEET #13: EARLY INTERVENTION STRATEGIES AND DEVELOPMENTAL ASSESSMENTS ........................97 SECTION II REFERENCES ..............................................................................................................................................................................100 Section III: Maternal Postnatal Care ................................................................................................................................................................110 FACTSHEET #14: ADJUSTING PHARMACOTHERAPY DOSE POSTPARTUM ..................................................................... 112 FACTSHEET #15: MATERNAL DISCHARGE PLANNING.................................................................................................................. 115 FACTSHEET #16: MATERNAL RETURN TO SUBSTANCE USE....................................................................................................119 SECTION III REFERENCES..............................................................................................................................................................................123 Part C: Conclusion ....................................................................................................................................................................................................126
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