Current Research on Opioid Use Disorder (OUD) in Pregnancy with Emphasis on Medication Assisted Treatment (MAT)
Main Article Content
Abstract
Substance use disorder in pregnancy is a major obstetric issue, with significant maternal and fetal morbidity and mortality. The incidence of opioid use disorder has risen substantially in the United States, with overdose now a leading contributor to pregnancy related deaths. Medication assisted treatment for opioid use disorder can improve pregnancy outcomes, with Methadone, and more recently Buprenorphine becoming the mainstays of treatment. There is decreased incidence of neonatal abstinence syndrome with maternal Buprenorphine use, as well as possible decreased association with neonatal low birth weight. Despite the known benefits of treatment, there remain barriers to medication assisted treatment, including clinician stigma and lack of familiarity with pharmacology. The American College of Obstetrics and Gynecology maintains a firm stance on the benefits of treatment during pregnancy, in order to avoid the known adverse outcomes associated with substance abuse during pregnancy. Pregnancy is period when most women routinely seek healthcare, and thus allows the opportunity for obstetrical providers to optimize maternal well-being. The goals during pregnancy remain the same as those outside of pregnancy: For medication treatment to assist in the prevention of a chronic and remitting condition that can result in overdose, and provide a gateway towards long-term recovery.
Article Details
How to Cite
CHOKSHI, Ravi et al.
Current Research on Opioid Use Disorder (OUD) in Pregnancy with Emphasis on Medication Assisted Treatment (MAT).
Medical Research Archives, [S.l.], v. 12, n. 8, aug. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5736>. Date accessed: 04 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i8.5736.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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3. Krans EE, Kim JY, James AE, Kelley D, Jarlenski MP. Medication-Assisted Treatment Use Among Pregnant Women with Opioid Use Disorder. Obstetrics & Gynecology. 2019;133(5):943-951. doi:10.1097/AOG.0000000000003231
4. Henkhaus LE, Buntin MB, Henderson SC, Lai P, Patrick SW. Disparities in Receipt of Medications for Opioid use Disorder among Pregnant Women. Subst Abus. 2022;43(1):508-513. doi:10.1080/08897077.2021.1949664
5. Patrick SW, Richards MR, Dupont WD, et al. Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder. JAMA Netw Open. 2020;3(8):e2013456. doi:10.1001/jamanetworkopen.2020.13456
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8. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020;14(2S):1-91. doi:10.1097/ADM.0000000000000633
9. Albutt C, Dixon W. Opium Poisoning and Other Intoxications. (Albutt CR, Humphry, eds.).; 1909.
10. Zelson C, Lee SJ, Casalino M. Neonatal narcotic addiction. Comparative effects of maternal intake of heroin and methadone. N Engl J Med. 1973;289(23):1216-1220. doi:10.1056/NEJM197312062892303
11. Stern R. The pregnant addict. Am J Obstet Gynecol. 1966;94(2):253-257. doi:10.1016/0002-9378(66)90472-8
12. Kocherlakota P. Neonatal Abstinence Syndrome. Pediatrics. 2014;134(2):e547-e561. doi:10.1542/peds.2013-3524
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14. Carrasco M, Rao SC, Bearer CF, Sundararajan S. Neonatal Gabapentin Withdrawal Syndrome. Pediatr Neurol. 2015;53(5):445-447. doi:10.1016/j.pediatrneurol.2015.06.023
15. Dhaliwal A, Gupta M. Physiology, Opioid Receptor.; 2023.
16. Elkader A, Sproule B. Buprenorphine. Clin Pharmacokinet. 2005;44(7):661-680. doi:10.2165/00003088-200544070-00001
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18. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet].; 2016.
19. Jordan M, Morrisonponce D. Naloxone. StatPearls.
20. Holbrook AM. Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma. Am J Drug Alcohol Abuse. 2015;41(5):371-373. doi:10.3109/00952990.2015.1059625
21. Jones HE, Finnegan LP, Kaltenbach K. Methadone and Buprenorphine for the Management of Opioid Dependence in Pregnancy. Drugs. 2012;72(6):747-757. doi:10.2165/11632820-000000000-00000
22. Suarez EA, Huybrechts KF, Straub L, et al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. New England Journal of Medicine. 2022;387(22):2033-2044. doi:10.1056/NEJMoa2203318
23. Brogly SB, Saia KA, Walley AY, Du HM, Sebastiani P. Prenatal Buprenorphine Versus Methadone Exposure and Neonatal Outcomes: Systematic Review and Meta-Analysis. Am J Epidemiol. 2014;180(7):673-686. doi:10.1093/aje/kwu190
24. Johnson RE, Jaffe JH, Fudala PJ. A controlled trial of buprenorphine treatment for opioid dependence. JAMA. 1992;267(20):2750-2755.
25. Perry BN, Vais S, Boateng JO, Jain M, Wachman EM, Saia KA. Buprenorphine-naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy. J Addict Med. 2022;16(6):e399-e404. doi:10.1097/ADM.0000000000001004
26. Towers C V., Deisher H. Subcutaneous Extended-Release Buprenorphine Use in Pregnancy. Case Rep Obstet Gynecol. 2020;2020:1-3. doi:10.1155/2020/3127676
27. Cleary EM, Byron RK, Hinely KA, Talley AW, Costantine MM, Rood KM. Subcutaneous Buprenorphine Extended-Release Use Among Pregnant and Postpartum Women. Obstetrics & Gynecology. 2020;136(5):902-903. doi:10.1097/AOG.0000000000004126
28. Meyer MC, Johnston AM, Crocker AM, Heil SH. Methadone and Buprenorphine for Opioid Dependence During Pregnancy. J Addict Med. 2015;9(2):81-86. doi:10.1097/ADM.0000000000000092
29. Jones HE, Kaltenbach K, Heil SH, et al. Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure. New England Journal of Medicine. 2010;363(24):2320-2331. doi:10.1056/NEJMoa1005359
30. Bastian JR, Chen H, Zhang H, et al. Dose-adjusted plasma concentrations of sublingual buprenorphine are lower during than after pregnancy. Am J Obstet Gynecol. 2017;216(1):64.e1-64.e7. doi:10.1016/j.ajog.2016.09.095
31. Towers C V., Terry P, Rackley B, Hennessy M, Visconti K. Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review. Am J Perinatol. 2020;37(07):679-688. doi:10.1055/s-0039-1688908
32. Macfie J, Towers C V., Fortner KB, et al. Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Addictive Behaviors Reports. 2020;12:100315. doi:10.1016/j.abrep.2020.100315
33. Bell J, Towers C V., Hennessy MD, Heitzman C, Smith B, Chattin K. Detoxification from opiate drugs during pregnancy. Am J Obstet Gynecol. 2016;215(3):374.e1-374.e6. doi:10.1016/j.ajog.2016.03.015
34. Guille C, Jones HE, Abuhamad A, Brady KT. Shared Decision‐Making Tool for Treatment of Perinatal Opioid Use Disorder. Psychiatric Research and Clinical Practice. 2019;1(1):27-31. doi:10.1176/appi.prcp.20180004
35. Jones HE. Acceptance of Naltrexone by Pregnant Women Enrolled in Comprehensive Drug Addiction Treatment: An Initial Survey. Am J Addict. 2012;21(3):199-201. doi:10.1111/j.1521-0391.2012.00229.x
36. Wachman EM, Saia K, Miller M, et al. Naltrexone Treatment for Pregnant Women With Opioid Use Disorder Compared With Matched Buprenorphine Control Subjects. Clin Ther. 2019;41(9):1681-1689. doi:10.1016/j.clinthera.2019.07.003
37. Towers C V., Katz E, Weitz B, Visconti K. Use of naltrexone in treating opioid use disorder in pregnancy. Am J Obstet Gynecol. 2020;222(1):83.e1-83.e8. doi:10.1016/j.ajog.2019.07.037
38. Deflorimonte C, Glissendorf V, Hofer J, et al. National Provider Survey: Use of Naltrexone for Pregnant Individuals with Substance Use Disorders. J Addict Med. 2023;17(6):736-738. doi:10.1097/ADM.0000000000001225
39. Tran TH, Griffin BL, Stone RH, Vest KM, Todd TJ. Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2017;37(7):824-839. doi:10.1002/phar.1958
40. Caritis SN, Panigrahy A. Opioids affect the fetal brain: reframing the detoxification debate. Am J Obstet Gynecol. 2019;221(6):602-608. doi:10.1016/j.ajog.2019.07.022
41. Caritis SN, Venkataramanan R. Naltrexone use in pregnancy: a time for change. Am J Obstet Gynecol. 2020;222(1):1-2. doi:10.1016/j.ajog.2019.08.041
42. Kocherlakota P. Neonatal Abstinence Syndrome. Pediatrics. 2014;134(2):e547-e561. doi:10.1542/peds.2013-3524
43. West KD, Ali MM, Blanco M, Natzke B, Nguyen L. Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016–2020 Transformed Medicaid Statistical Information System. Matern Child Health J. Published online May 23, 2023. doi:10.1007/s10995-023-03670-z
44. FDA announces safety labeling changes and postmarket study requirements for extended-release and long-acting opioid analgesics . FDA News Release. Published 2013. Accessed November 23, 2023. FDA announces safety labeling changes and postmarket study requirements for extended-release and long-acting opioid analgesics
45. Jilani SM, Jordan CJ, Jansson LM, Davis JM. Definitions of neonatal abstinence syndrome in clinical studies of mothers and infants: an expert literature review. Journal of Perinatology. 2021;41(6):1364-1371. doi:10.1038/s41372-020-00893-8
46. Sherman LJ, Ali MM, Mutter R, Larson J. Mental Disorders Among Children Born With Neonatal Abstinence Syndrome. Psychiatr Serv. 2019;70(2):151. doi:10.1176/appi.ps.201800341
47. Baldacchino A, Arbuckle K, Petrie DJ, McCowan C. Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis. BMC Psychiatry. 2014;14(1):104. doi:10.1186/1471-244X-14-104
48. Fill MMA, Miller AM, Wilkinson RH, et al. Educational Disabilities Among Children Born With Neonatal Abstinence Syndrome. Pediatrics. 2018;142(3). doi:10.1542/peds.2018-0562
49. Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr. 1991;118(6):933-937. doi:10.1016/s0022-3476(05)82214-0
50. Amiri S, Nair J. Gestational Age Alters Assessment of Neonatal Abstinence Syndrome. Pediatr Rep. 2022;14(1):50-57. doi:10.3390/pediatric14010009
51. Davis JM, Shenberger J, Terrin N, et al. Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Clinical Trial. JAMA Pediatr. 2018;172(8):741-748. doi:10.1001/jamapediatrics.2018.1307
52. Patrick SW, Frank RG, McNeer E, Stein BD. Improving the Child Welfare System to Respond to the Needs of Substance-Exposed Infants. Hosp Pediatr. 2019;9(8):651-654. doi:10.1542/hpeds.2019-0106
53. Chasnoff IJ, Landress HJ, Barrett ME. The Prevalence of Illicit-Drug or Alcohol Use during Pregnancy and Discrepancies in Mandatory Reporting in Pinellas County, Florida. New England Journal of Medicine. 1990;322(17):1202-1206. doi:10.1056/NEJM199004263221706
54. Zwick J, Appleseth H, Arndt S. Stigma: how it affects the substance use disorder patient. Subst Abuse Treat Prev Policy. 2020;15(1):50. doi:10.1186/s13011-020-00288-0
55. Recovery and Recovery Support. SAMSHA. Published 2023. Accessed November 23, 2023. https://www.samhsa.gov/find-help/recovery
Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families. Treatment Improvement Protocol TIP 63. Substance Abuse and Mental Health Services Administration. Update 2021.
Substance Abuse and Mental Health Services Administration; Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington (DC): US Department of Health and Human Services; November 2016.
Substance Abuse and Mental Health Services Administration. Federal Guidelines for Opioid Treatment Programs. HHS Publication. SMA # PEP15-FEDGUIDEOTP. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl. Providers Clinical Support System. May 2023. https://pcssnow.org/courses/practice-based-guidelines-buprenorphine-in-the-age-of-fentanyl-pcss-guidance/. Accessed June 13, 2023.
2. Schiff DM, Nielsen T, Hoeppner BB, et al. Assessment of Racial and Ethnic Disparities in the Use of Medication to Treat Opioid Use Disorder Among Pregnant Women in Massachusetts. JAMA Netw Open. 2020;3(5):e205734. doi:10.1001/jamanetworkopen.2020.5734
3. Krans EE, Kim JY, James AE, Kelley D, Jarlenski MP. Medication-Assisted Treatment Use Among Pregnant Women with Opioid Use Disorder. Obstetrics & Gynecology. 2019;133(5):943-951. doi:10.1097/AOG.0000000000003231
4. Henkhaus LE, Buntin MB, Henderson SC, Lai P, Patrick SW. Disparities in Receipt of Medications for Opioid use Disorder among Pregnant Women. Subst Abus. 2022;43(1):508-513. doi:10.1080/08897077.2021.1949664
5. Patrick SW, Richards MR, Dupont WD, et al. Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder. JAMA Netw Open. 2020;3(8):e2013456. doi:10.1001/jamanetworkopen.2020.13456
6. Henkhaus LE, Buntin MB, Henderson SC, Lai P, Patrick SW. Disparities in Receipt of Medications for Opioid use Disorder among Pregnant Women. Subst Abus. 2022;43(1):508-513. doi:10.1080/08897077.2021.1949664
7. Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy. Obstetrics & Gynecology. 2017;130(2):e81-e94. doi:10.1097/AOG.0000000000002235
8. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020;14(2S):1-91. doi:10.1097/ADM.0000000000000633
9. Albutt C, Dixon W. Opium Poisoning and Other Intoxications. (Albutt CR, Humphry, eds.).; 1909.
10. Zelson C, Lee SJ, Casalino M. Neonatal narcotic addiction. Comparative effects of maternal intake of heroin and methadone. N Engl J Med. 1973;289(23):1216-1220. doi:10.1056/NEJM197312062892303
11. Stern R. The pregnant addict. Am J Obstet Gynecol. 1966;94(2):253-257. doi:10.1016/0002-9378(66)90472-8
12. Kocherlakota P. Neonatal Abstinence Syndrome. Pediatrics. 2014;134(2):e547-e561. doi:10.1542/peds.2013-3524
13. Huybrechts KF, Bateman BT, Desai RJ, et al. Risk of neonatal drug withdrawal after intrauterine co-exposure to opioids and psychotropic medications: cohort study. BMJ. Published online August 2, 2017:j3326. doi:10.1136/bmj.j3326
14. Carrasco M, Rao SC, Bearer CF, Sundararajan S. Neonatal Gabapentin Withdrawal Syndrome. Pediatr Neurol. 2015;53(5):445-447. doi:10.1016/j.pediatrneurol.2015.06.023
15. Dhaliwal A, Gupta M. Physiology, Opioid Receptor.; 2023.
16. Elkader A, Sproule B. Buprenorphine. Clin Pharmacokinet. 2005;44(7):661-680. doi:10.2165/00003088-200544070-00001
17. Trescot AM, Datta S, Lee M, Hansen H. Opioid pharmacology. Pain Physician. 2008;11(2 Suppl):S133-53.
18. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health [Internet].; 2016.
19. Jordan M, Morrisonponce D. Naloxone. StatPearls.
20. Holbrook AM. Methadone versus buprenorphine for the treatment of opioid abuse in pregnancy: science and stigma. Am J Drug Alcohol Abuse. 2015;41(5):371-373. doi:10.3109/00952990.2015.1059625
21. Jones HE, Finnegan LP, Kaltenbach K. Methadone and Buprenorphine for the Management of Opioid Dependence in Pregnancy. Drugs. 2012;72(6):747-757. doi:10.2165/11632820-000000000-00000
22. Suarez EA, Huybrechts KF, Straub L, et al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. New England Journal of Medicine. 2022;387(22):2033-2044. doi:10.1056/NEJMoa2203318
23. Brogly SB, Saia KA, Walley AY, Du HM, Sebastiani P. Prenatal Buprenorphine Versus Methadone Exposure and Neonatal Outcomes: Systematic Review and Meta-Analysis. Am J Epidemiol. 2014;180(7):673-686. doi:10.1093/aje/kwu190
24. Johnson RE, Jaffe JH, Fudala PJ. A controlled trial of buprenorphine treatment for opioid dependence. JAMA. 1992;267(20):2750-2755.
25. Perry BN, Vais S, Boateng JO, Jain M, Wachman EM, Saia KA. Buprenorphine-naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy. J Addict Med. 2022;16(6):e399-e404. doi:10.1097/ADM.0000000000001004
26. Towers C V., Deisher H. Subcutaneous Extended-Release Buprenorphine Use in Pregnancy. Case Rep Obstet Gynecol. 2020;2020:1-3. doi:10.1155/2020/3127676
27. Cleary EM, Byron RK, Hinely KA, Talley AW, Costantine MM, Rood KM. Subcutaneous Buprenorphine Extended-Release Use Among Pregnant and Postpartum Women. Obstetrics & Gynecology. 2020;136(5):902-903. doi:10.1097/AOG.0000000000004126
28. Meyer MC, Johnston AM, Crocker AM, Heil SH. Methadone and Buprenorphine for Opioid Dependence During Pregnancy. J Addict Med. 2015;9(2):81-86. doi:10.1097/ADM.0000000000000092
29. Jones HE, Kaltenbach K, Heil SH, et al. Neonatal Abstinence Syndrome after Methadone or Buprenorphine Exposure. New England Journal of Medicine. 2010;363(24):2320-2331. doi:10.1056/NEJMoa1005359
30. Bastian JR, Chen H, Zhang H, et al. Dose-adjusted plasma concentrations of sublingual buprenorphine are lower during than after pregnancy. Am J Obstet Gynecol. 2017;216(1):64.e1-64.e7. doi:10.1016/j.ajog.2016.09.095
31. Towers C V., Terry P, Rackley B, Hennessy M, Visconti K. Fetal Outcomes with Detoxification from Opioid Drugs during Pregnancy: A Systematic Review. Am J Perinatol. 2020;37(07):679-688. doi:10.1055/s-0039-1688908
32. Macfie J, Towers C V., Fortner KB, et al. Medication-assisted treatment vs. detoxification for women who misuse opioids in pregnancy: Associations with dropout, relapse, neonatal opioid withdrawal syndrome (NOWS), and childhood sexual abuse. Addictive Behaviors Reports. 2020;12:100315. doi:10.1016/j.abrep.2020.100315
33. Bell J, Towers C V., Hennessy MD, Heitzman C, Smith B, Chattin K. Detoxification from opiate drugs during pregnancy. Am J Obstet Gynecol. 2016;215(3):374.e1-374.e6. doi:10.1016/j.ajog.2016.03.015
34. Guille C, Jones HE, Abuhamad A, Brady KT. Shared Decision‐Making Tool for Treatment of Perinatal Opioid Use Disorder. Psychiatric Research and Clinical Practice. 2019;1(1):27-31. doi:10.1176/appi.prcp.20180004
35. Jones HE. Acceptance of Naltrexone by Pregnant Women Enrolled in Comprehensive Drug Addiction Treatment: An Initial Survey. Am J Addict. 2012;21(3):199-201. doi:10.1111/j.1521-0391.2012.00229.x
36. Wachman EM, Saia K, Miller M, et al. Naltrexone Treatment for Pregnant Women With Opioid Use Disorder Compared With Matched Buprenorphine Control Subjects. Clin Ther. 2019;41(9):1681-1689. doi:10.1016/j.clinthera.2019.07.003
37. Towers C V., Katz E, Weitz B, Visconti K. Use of naltrexone in treating opioid use disorder in pregnancy. Am J Obstet Gynecol. 2020;222(1):83.e1-83.e8. doi:10.1016/j.ajog.2019.07.037
38. Deflorimonte C, Glissendorf V, Hofer J, et al. National Provider Survey: Use of Naltrexone for Pregnant Individuals with Substance Use Disorders. J Addict Med. 2023;17(6):736-738. doi:10.1097/ADM.0000000000001225
39. Tran TH, Griffin BL, Stone RH, Vest KM, Todd TJ. Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2017;37(7):824-839. doi:10.1002/phar.1958
40. Caritis SN, Panigrahy A. Opioids affect the fetal brain: reframing the detoxification debate. Am J Obstet Gynecol. 2019;221(6):602-608. doi:10.1016/j.ajog.2019.07.022
41. Caritis SN, Venkataramanan R. Naltrexone use in pregnancy: a time for change. Am J Obstet Gynecol. 2020;222(1):1-2. doi:10.1016/j.ajog.2019.08.041
42. Kocherlakota P. Neonatal Abstinence Syndrome. Pediatrics. 2014;134(2):e547-e561. doi:10.1542/peds.2013-3524
43. West KD, Ali MM, Blanco M, Natzke B, Nguyen L. Prenatal Substance Exposure and Neonatal Abstinence Syndrome: State Estimates from the 2016–2020 Transformed Medicaid Statistical Information System. Matern Child Health J. Published online May 23, 2023. doi:10.1007/s10995-023-03670-z
44. FDA announces safety labeling changes and postmarket study requirements for extended-release and long-acting opioid analgesics . FDA News Release. Published 2013. Accessed November 23, 2023. FDA announces safety labeling changes and postmarket study requirements for extended-release and long-acting opioid analgesics
45. Jilani SM, Jordan CJ, Jansson LM, Davis JM. Definitions of neonatal abstinence syndrome in clinical studies of mothers and infants: an expert literature review. Journal of Perinatology. 2021;41(6):1364-1371. doi:10.1038/s41372-020-00893-8
46. Sherman LJ, Ali MM, Mutter R, Larson J. Mental Disorders Among Children Born With Neonatal Abstinence Syndrome. Psychiatr Serv. 2019;70(2):151. doi:10.1176/appi.ps.201800341
47. Baldacchino A, Arbuckle K, Petrie DJ, McCowan C. Neurobehavioral consequences of chronic intrauterine opioid exposure in infants and preschool children: a systematic review and meta-analysis. BMC Psychiatry. 2014;14(1):104. doi:10.1186/1471-244X-14-104
48. Fill MMA, Miller AM, Wilkinson RH, et al. Educational Disabilities Among Children Born With Neonatal Abstinence Syndrome. Pediatrics. 2018;142(3). doi:10.1542/peds.2018-0562
49. Doberczak TM, Kandall SR, Wilets I. Neonatal opiate abstinence syndrome in term and preterm infants. J Pediatr. 1991;118(6):933-937. doi:10.1016/s0022-3476(05)82214-0
50. Amiri S, Nair J. Gestational Age Alters Assessment of Neonatal Abstinence Syndrome. Pediatr Rep. 2022;14(1):50-57. doi:10.3390/pediatric14010009
51. Davis JM, Shenberger J, Terrin N, et al. Comparison of Safety and Efficacy of Methadone vs Morphine for Treatment of Neonatal Abstinence Syndrome: A Randomized Clinical Trial. JAMA Pediatr. 2018;172(8):741-748. doi:10.1001/jamapediatrics.2018.1307
52. Patrick SW, Frank RG, McNeer E, Stein BD. Improving the Child Welfare System to Respond to the Needs of Substance-Exposed Infants. Hosp Pediatr. 2019;9(8):651-654. doi:10.1542/hpeds.2019-0106
53. Chasnoff IJ, Landress HJ, Barrett ME. The Prevalence of Illicit-Drug or Alcohol Use during Pregnancy and Discrepancies in Mandatory Reporting in Pinellas County, Florida. New England Journal of Medicine. 1990;322(17):1202-1206. doi:10.1056/NEJM199004263221706
54. Zwick J, Appleseth H, Arndt S. Stigma: how it affects the substance use disorder patient. Subst Abuse Treat Prev Policy. 2020;15(1):50. doi:10.1186/s13011-020-00288-0
55. Recovery and Recovery Support. SAMSHA. Published 2023. Accessed November 23, 2023. https://www.samhsa.gov/find-help/recovery
Medications for Opioid Use Disorder: For Healthcare and Addiction Professionals, Policymakers, Patients, and Families. Treatment Improvement Protocol TIP 63. Substance Abuse and Mental Health Services Administration. Update 2021.
Substance Abuse and Mental Health Services Administration; Office of the Surgeon General (US). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. Washington (DC): US Department of Health and Human Services; November 2016.
Substance Abuse and Mental Health Services Administration. Federal Guidelines for Opioid Treatment Programs. HHS Publication. SMA # PEP15-FEDGUIDEOTP. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.
Practice-Based Guidelines: Buprenorphine in the Age of Fentanyl. Providers Clinical Support System. May 2023. https://pcssnow.org/courses/practice-based-guidelines-buprenorphine-in-the-age-of-fentanyl-pcss-guidance/. Accessed June 13, 2023.