Opioid Use and Abuse

Question 1

In your practice, do you screen all pregnant women for substance abuse?

Answer 1

Yes, with questions during history taking and not with UDS

Question 2

If a patient screens positive for history of substance abuse, what are your next steps?

Answer 2

• Assess desire for cessation
• Route to program that can help with cessation
• Social work or nurse navigator involvement

Question 3

What would you discuss in a brief intervention with patient?

Answer 3

engage the patient in a short conversation, providing feedback and advice.

• assess for withdrawal symptoms
• assess desire to quit
• assess social situation
• discuss recommendation and resources to help

Question 4

How do you manage opioid use disorder in pregnancy?

Answer 4

• initiate medication assistance with buprenorphine or methadone
• assess for signs of withdrawal dysmorphic mood, nausea/vomiting, muscle aches, lacrimation, rhinorrhea, diaphoresis, diarrhea, yawning, fever, insomnia
• fetal growth due to risk of IUGR

Question 5

Do you recommend medication assistant treatment for patients with opioid use disorder?

Answer 5

yes. found to decrease risk of relapse

Question 6

What is neonatal abstinence syndrome?

Answer 6

neonatal abstinence syndrome (NAS), which can occur as early as 48 hours after birth until a month of life and involves sleep disturbances, high pitch cry, failure to thrive and issues with feeding.

Question 7

What are risks and benefit of methadone in pregnancy?

Answer 7

Benefits include increase survival, increase treatment retention, decrease illicit opioid use, decrease hepatitis/HIV seroconversion and increases better fetal outcomes compared to women who are actively misusing opioids. Increase job retention

Risks include neonatal abstinence syndrome , neonatal visual changes

Question 8

What are risks and benefit of buprenorphine in pregnancy?

Answer 8

Benefits include increase survival, increase treatment retention, decrease illicit opioid use, decrease hepatitis/HIV seroconversion and increases better fetal outcomes compared to women who are actively misusing opioids. No need for daily visits

Risk: NAS (less likely compared to methadone), risk of overdose

Question 9

What are maternal and fetal risks of opioid abuse in pregnancy?

Answer 9

IUGR, placental abruption, fetal death, preterm labor, and intrauterine passage of meconium.

Question 10

What are maternal risks of opioid withdrawal?

Answer 10

dysmorphic mood, nausea/vomiting, muscle aches, lacrimation, rhinorrhea, diaphoresis, diarhea, yawning, fever, insomnia

Question 11

What are fetal risks of opioid withdrawal?

Answer 11

SAB

Question 12

What are the maternal and fetal risks of amphetamine and cocaine use in pregnancy?

Answer 12

• Hypertension
• Stroke
• MI
• Abruption
• IUGR
• IUFD