Overdose Epidemic

5 keys to prevent opioid overdoses during pregnancy and postpartum

Jennifer Lubell , Contributing News Writer

Opioid-related overdoses have become a leading cause of maternal death in recent years, with mortality rates rising more than 80% between 2017 and 2020. The statistics, included in a report issued by the AMA and consulting firm Manatt Health, show the need to improve care during and after pregnancy for patients with opioid use disorder (OUD).

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Medications such as buprenorphine and methadone are first-line therapy options for people with opioid use disorder, but structural barriers hinder access to evidence-based care for people with OUD. The AMA-Manatt Health report (PDF) outlines five strategies that states should take to improve access to medications for opioid use disorder during pregnancy and postpartum.

“The escalating rise of drug-related overdose deaths during and immediately after pregnancy demands that state policymakers act now to improve outcomes for these individuals, newborns and families,” AMA President Jesse M. Ehrenfeld, MD, MPH, said in a statement. “Improving evidence-based medical care during pregnancy for patients who have substance-use disorders must start with compassion.”

Untreated opioid use disorder can destabilize a pregnancy and lead to complications such as low birth weight, preterm labor, fetal distress and death. Pregnant patients with opioid use disorders also risk being reported to child protective services and face potential removal of their infant and other children.

Some states have responded by taking a nonpunitive, public health approach to address this crisis and others should follow their lead, Dr. Ehrenfeld said.

According to the AMA-Manatt Health report, states should take evidence-based, lifesaving steps to:

  • Support access to medications for opioid use disorder given that is the standard of care for OUD in pregnancy.
  • Ensure that pregnant and postpartum patients are supported—and not punished—for receiving medications for opioid use disorder.
  • Improve data collection and state partnerships to ensure equitable access to treatment.
  • Require correctional facilities and judicially supervised diversion programs to provide access to medications for opioid use disorder and institute universal OUD screening.
  • Guarantee Medicaid coverage and access to prerelease services for all incarcerated people.

Notably, more than one-quarter of pregnant patients entering prison have opioid use disorder and 14% of those going to jail do. Despite that, only 60% of jails provide medications for OUD, according to a JAMA Network Open study cited in the AMA-Manatt Health report.

The AMA is tired of seeing families torn apart by policies that are punishing pregnant people because they have a substance-use disorder, Dr. Ehrenfeld said during a webinar highlighting the report.

“We want a put an end to that,” he said. “We want to end policies that create a situation where pregnant people are scared because they have a substance-use disorder and they're not getting the prenatal care that they need and deserve.”

Pregnant and postpartum patients with opioid use disorder face a great deal of stigma. They need to be treated with kindness and compassion, said addiction medicine specialist Cara Poland, MD, MEd, an associate professor at the Michigan State University College of Human Medicine who was one of several physician experts who took part in the webinar.

“Being able to offer them medications, prescribing medications where appropriate, offering any sort of psychosocial or social determinants of health support as well as therapy and recovery coaching can be very helpful,” she said.

Also sharing their expertise for the webinar were:

  • Jocelyn Guyer, senior managing director at Manatt Health.
  • Kimberly Sue, MD, PhD, assistant professor of medicine, Yale University School fo Medicine; author of Getting Wrecked: Women, Incarceration, and the American Opioid Crisis.
  • Mishka Terplan, MD, MPH, medical director and senior research scientist at the Friends Research Institute.

Watch the webinar now (registration required).

Learn more with Dr. Poland and the AMA about opioid use disorder and pregnancy in an episode that is part of the CME-eligible “Opioid Overdose Podcast Series” on AMA Ed Hub™️.

The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website.