SUD 101: Best Clinical Practices for Treating Opioid Use Disorder in Pregnancy and the Postpartum Period-Course Content

Video Transcription

Video Summary

The transcript is a lecture by Dr. Andre Jones on best practices for treating opioid use disorder (OUD) during pregnancy and the postpartum period. It emphasizes that opioid use in women has a long history, shaped by medical prescribing patterns, policy changes, and the evolution of the opioid crisis from prescription opioids to heroin and fentanyl. Pregnancy does not protect against overdose; in fact, overdose is a leading cause of maternal mortality, including in the late postpartum period.<br /><br />The lecture strongly supports medication treatment for OUD, especially methadone and buprenorphine, as the standard of care in pregnancy and postpartum. It explains that medically assisted withdrawal/detoxification is generally not recommended because it often leads to relapse and overdose risk. Evidence from studies like the MOTHER trial shows that both methadone and buprenorphine are effective, with buprenorphine often associated with less severe neonatal opioid withdrawal and shorter hospital stays. Shared decision-making, patient choice, and individualized dosing—including split dosing—are key.<br /><br />Dr. Jones also highlights the importance of trauma-informed, nonjudgmental, person-first care. Providers should ask about barriers such as stigma, transportation, housing, insurance, and fear of child welfare involvement. Drug testing should be used cautiously, with informed consent and awareness of its limitations.<br /><br />For newborns, the talk explains neonatal abstinence syndrome/neonatal opioid withdrawal, newer assessment approaches like “eat, sleep, and console,” and the benefits of keeping mother and baby together. Breastfeeding is recommended for patients on methadone or buprenorphine, and postpartum care should include pain management, mood screening, and a clear follow-up plan to prevent loss to care.

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Keywords

opioids

chronic pain

pain management

opioid prescribing

overdose risk

fentanyl

methadone

physical dependence

universal precautions

naloxone

non-opioid therapies

substance use disorder

opioid use disorder

pregnancy

postpartum care

buprenorphine

medication treatment

medically assisted withdrawal

overdose prevention

maternal mortality

neonatal opioid withdrawal

breastfeeding

trauma-informed care

shared decision-making

eat sleep and console