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Guidance Released to Help Pregnant and Parenting Women with Opioid Use Disorder and Their Children; New Report Says States Need More Support to Address the Issue

February 08, 2018

The Substance Abuse and Mental Health Services Administration (SAMHSA) has released new Clinical Guidance for Treating Pregnant and Parenting Women with Opioid Use Disorder and Their Infants.   

According to SAMHSA, during 2016, more than 20,000 pregnant women reported using heroin or misusing pain relievers during the past month. Newborn babies of mothers who used opioids while pregnant are at risk of neonatal abstinence syndrome (NAS), a group of physical and neurobehavioral signs of withdrawal.

The guidance provides critical information to help health care professionals treat opioid-dependent mothers and their children, and ensure impacted mothers and infants safely receive treatment for opioid use disorder and NAS.

Using a scenario format, the guidance offers clinical action steps and supporting evidence. The action steps promote best treatment practices, including medication-assisted treatment for the mother and infant. They also recommend appropriate types of social supports and follow-up services.

The guidance includes 16 fact sheets about prenatal, infant, and maternal postnatal care. There are four elements; clinical scenario, clinical action steps, supporting evidence, and clinical considerations; as well as web resources.

The guidance comes out on the heels of a U.S. Government Accountability Office (GAO) report, requested by U.S. Senator Bob Casey (D-PA), about how state agencies report drug-affected infants to child protective services. The report indicates agencies remain confused about reporting. Many do not want to punish mothers, but help families and ensure the child’s safety. Thirty-eight states said more guidance would be “extremely to very helpful.” Advocates who provided input are calling for greater coordination and funding to help pregnant women and infants impacted by the opioid epidemic.

GAO interviewed stakeholders and reviewed literature, and identified several recommended practices and challenges associated with addressing NAS. The most frequently cited challenges included the

  • Maternal use of multiple drugs—or polysubstance use
  • Stigma faced by pregnant women who use opioids
  • Hospital staff burden and limited physical capacity to care for infants with NAS
  • Limited coordination of care for mothers and infants with NAS
  • Gaps in research and data about NAS, such as research about the long-term effects of the condition

Senator Casey is the leading Democrat on the Children and Families Subcommittee of the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee. He has been a strong advocate in addressing the opioid epidemic, particularly in helping families dealing with opioid use disorder. Pennsylvania Governor Tom Wolf’s proposed state budget calls for additional resources for home visitations to help families, mothers, and babies impacted by the opioid crisis. A HELP Committee hearing today reviewed the impact of the opioid crisis on children and families.

HAP currently participates on a task force that is addressing infants with substance exposure. For information about HAP’s clinical work around the opioid crisis, contact Dr. Michael Consuelos, HAP’s senior vice president, clinical integration. For information about federal and state advocacy efforts, contact Laura Stevens Kent, HAP’s vice president, federal legislative advocacy, and Scott Bishop, HAP’s senior vice president, legislative services.

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