Medical specialty of buprenorphine prescribers for pregnant women with opioid use disorder

Hollander, Mara A.G.; Jarlenski, Marian; Donohue, Julie M.; Cole, Evan S.; Kelley, David

doi:10.1016/j.ajog.2019.01.226

Cited by 15 publications

(12 citation statements)

References 4 publications

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“… 15 , 24 , 25 Even among women with OUD who are pregnant and enrolled in Medicaid, primary care physicians and psychiatrists are the leading prescribers of buprenorphine, followed by obstetrician-gynecologists. 47 Clinicians face barriers to becoming X-waivered, including low psychosocial support, time constraints, and stigma from colleagues and office staff, which altogether may also contribute to this low rate. 48 , 49 , 50 Some obstetrician-gynecologists who are not X-waivered may work in collaboration with psychiatrists or primary care physicians to whom they refer their patients for buprenorphine, but studies show that women who are pregnant are unevenly screened and referred to treatment by their obstetrician-gynecologists after screening positive for substance use disorders, 51 despite what guidelines recommend.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

et al. 2020

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Key Points Question What is the geographic distribution across the US and prevalence of Medicaid-claimant obstetrician-gynecologists who are trained to prescribe buprenorphine? Findings In this cross-sectional study including 31 211 Medicaid-claimant obstetrician-gynecologists, fewer than 2% were trained to prescribe buprenorphine. In addition, these physicians were more likely to work in primarily suburban counties. Meaning Results of this study suggest that an opportunity exists for obstetrician-gynecologists to contribute to expanding the workforce of clinicians who can prescribe buprenorphine to further address the opioid epidemic’s association with maternal and infant morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

et al. 2020

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“…An analysis of OUD in pregnancy admissions between 1996 and 2014 revealed that while the number of admissions rose, the proportion of women receiving MAT was unchanged (Short, Hand, MacAfee, Abatemarco, & Terplan, 2018). Furthermore, inequality exists across states, races, and age, with non-White women, younger women, and women from southern states and rural areas receiving MAT less often (Hand et al, 2017; Hollander et al, 2019; Krans et al, 2016). This is also related to insurance coverage: In southern states, methadone treatment is covered by Medicaid less frequently than in northern states.…”

Section: Discussionmentioning

confidence: 99%

Contributions of psychology to research, treatment, and care of pregnant women with opioid use disorder.

Preis

Inman

Lobel

2020

American Psychologist

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The number of women with opioid use disorder (OUD) in the United States has risen precipitously. Pregnant women with OUD are a particularly vulnerable subset of addicted women with unique characteristics and needs. Many of them are impoverished, have strenuous life circumstances, are affected by past and current trauma, and have high rates of psychiatric comorbidities. Their addiction can compromise their and their infant's health, particularly without sufficient treatment including prenatal care, medication-assisted treatment (MAT), and social and behavioral care. Furthermore, these women's needs are often undetected and untreated: They may not seek appropriate prenatal and addiction care, or if they do, may face barriers to comprehensive, evidence-based treatment. Theories, methods, tools, and existing knowledge from the field of psychology are needed to improve research, prevention, and treatment for pregnant women with OUD. Although a number of psychologists have made critical contributions to research on pregnant women with OUD, we demonstrate by a scoping review of scientific literature and by examining American Psychological Association (APA) Annual Convention proceedings that much research on this population has been communicated in areas and journals outside psychology and among audiences other than psychologists. We identify relevant theoretical frameworks and methods to facilitate psychological investigation as well as evidence-based intervention and care for this population. Our field is well positioned to examine, identify, and alleviate the needs of pregnant women with OUD to improve their health and the health of their children. Public Significance StatementThis article suggests that research and care for pregnant women with opioid use disorder can be improved by greater involvement of the field of psychology. We present psychological theories, methods, tools, and existing knowledge that can be used to improve research about pregnant women with opioid use disorder and we discuss treatment approaches in which psychologists' expertise is valuable to provide and evaluate evidence-based, woman-centered, trauma-informed, integrated care.

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“…medications including buprenorphine, methadone, and naltrexone or basic harm-reducing interventions including motivational interviewing, naloxone coprescription, and anticipatory guidance about the risk of drug relapse, overdose, and death. 26,47,48 The collective lack of knowledge about addiction medicine in our field is likely a contributing factor to low rates of medication for OUD (MOUD) utilization and continuation in the obstetrical population. 49,50 Few medical curricula are teaching the fundamentals of OUD treatment, and even fewer are tailored to teaching obstetrical providers about specific considerations for this population, including dosing considerations, 51e54 recommendations against medication tapering, or discontinuation in pregnancy.…”

Section: Clinical Perspectivementioning

confidence: 99%

Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction

Smid

Schauberger

Terplan

et al. 2020

American Journal of Obstetrics & Gynecology MFM

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Understanding the Problem The United States is in the midst of a fatal drug crisis among pregnant and postpartum women-over the past 2 decades, the rates of opioid use disorder (OUD) have quadrupled. 1 Among reproductive-age women, drug-related death-death from poisoning caused by legal, illegal, or medically prescribed drugs-has emerged as a leading cause of death; however, less is understood about the circumstances and preventability of these deaths in pregnant and postpartum women. 2 Maternal mortality review committees (MMRCs) are 1 of 3 national surveillance mechanisms for maternal death in the United States. 3 Because the National Vital Statistics System and the Pregnancy Mortality Surveillance System rely primarily on birth and death certificates to capture maternal deaths, MMRCs are uniquely positioned to analyze the root causes of maternal drug-related deaths. As of February 2020, there were 48 MMRCs nationwide (46 states and 2 cities) that provide multidisciplinary reviews of pregnancy-associated and pregnancy-related deaths (Table 1) including identification of contributing factors and recommended solution at the patient, provider, community, facility, and system levels. Multiple MMRCs have recently reported that mental health conditions now account for a significant proportion of pregnancy-associated and pregnancy-related deaths. 1,3,6e8 Although most drug-related deaths have been

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Medical specialty of buprenorphine prescribers for pregnant women with opioid use disorder

Cited by 15 publications

References 4 publications

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

Contributions of psychology to research, treatment, and care of pregnant women with opioid use disorder.

Early lessons from maternal mortality review committees on drug-related deaths—time for obstetrical providers to take the lead in addressing addiction

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