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Evidence-Based OUD Treatment for Pregnant People in Arizona – Advisory March 2024

Evidence-Based OUD Treatment for Pregnant People in Arizona Advisory March 2024
In March 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) released an advisory on evidence-based, whole-person care for pregnant people with opioid use disorder (OUD). This advisory is particularly relevant to Arizona, where opioid use during pregnancy has been a growing concern. According to the Arizona Department of Health Services, there were 1,180 cases of neonatal abstinence syndrome (NAS) in 2021, representing a rate of 13.5 per 1,000 hospital births.
Confirmed and Suspected NAS Case, Arizona, 2017-2021

The rising trend in neonatal abstinence syndrome (NAS) in Arizona, from 592 cases in 2017 to 835 in 2021, underscores the critical need for integrated healthcare services that address both the medical and social determinants of health affecting pregnant individuals with opioid use disorder (OUD). Regional data from the Arizona Department of Health Services highlight the urgency for targeted interventions in high-impact areas. For example, Primary Care Areas (PCAs) such as Tucson Foothills, Tucson Central, and Apache Junction have reported the highest rates of NAS, indicating regions where comprehensive prenatal and postnatal care could be most effective.

Furthermore, the prevalence of NAS among different communities calls for a culturally sensitive approach. In 2021, American Indian/Alaska Native and Black/African American communities experienced the highest rates of NAS, emphasizing the need for community-specific healthcare programs that incorporate cultural beliefs and practices into treatment plans. This tailored approach can help in building trust and improving healthcare outcomes by addressing the unique challenges faced by these groups.

Total Charges, Charges Per Encounter, and Net Annual Charge in Total Charges, 2017-2021
The comprehensive hospital discharge data collected by Arizona’s health services, reflecting both inpatient and emergency department records, provide a robust foundation for monitoring and enhancing opioid use disorder treatment among pregnant populations. This data not only supports the need for systemic improvements in healthcare delivery but also underlines the significant economic impact of NAS. In 2021 alone, NAS cases led to over $71.6 million in hospital charges, highlighting the potential cost savings that effective whole-person care strategies could achieve.

The Importance of Evidence-Based Treatment

Medications for Opioid Use Disorder (MOUD)

  • The SAMHSA advisory emphasizes the importance of providing comprehensive, evidence-based care for pregnant people with OUD.
  • This includes the use of medications for opioid use disorder (MOUD), such as methadone and buprenorphine, which have been shown to be safe and effective during pregnancy.
  • These medications can help reduce the risk of maternal mortality, preterm birth, and low birth weight, as well as improve outcomes for infants born to mothers with OUD.
  • According to the advisory, “methadone and buprenorphine, when taken as prescribed, are safe and effective for treating OUD during pregnancy.”
  • However, despite the proven benefits of MOUD, many pregnant people in Arizona face barriers to accessing this evidence-based treatment.
  • SAMHSA reports that only 50-60% of pregnant people with OUD receive any form of medication treatment.

Comprehensive Care

  • In addition to MOUD, the SAMHSA advisory stresses the importance of providing whole-person care that addresses the unique needs of pregnant people with OUD.
  • This includes offering comprehensive prenatal care, counseling, and recovery support services.
  • Providers should also be aware of the increased risk of co-occurring mental health disorders among this population and screen for conditions such as depression and anxiety.

Barriers to Treatment

Limited Access to Specialized Care

  • Limited access to specialized care, particularly in rural areas, can also be a significant barrier to treatment.
  • According to SAMHSA, “long wait times for entry into OUD treatment, particularly in rural areas, can limit access, affect treatment rates, and potentially negatively affect the pregnant person and their baby.”
  • Arizona providers must work to increase access to specialized care and collaborate with community-based organizations to ensure patients have access to the full range of services they need.

Stigma and Lack of Education

  • Stigma and lack of provider education can contribute to the underutilization of MOUD during pregnancy.
  • The advisory states that “pregnant people, particularly those of color, may face increased stigma and discrimination and potential child welfare involvement if they are taking medications for OUD.”
  • Healthcare providers in Arizona must prioritize education and training on evidence-based OUD treatment for pregnant patients to help combat stigma and improve access to care.

The Role of Arizona Healthcare Providers

Arizona healthcare providers can play a crucial role in improving outcomes for pregnant people with OUD and their infants by adopting evidence-based practices and providing compassionate, non-stigmatizing care. This may involve:

  • Offering universal screening for substance use disorders during pregnancy.
  • Providing information on the safety and efficacy of MOUD.
  • Referring patients to appropriate treatment services when necessary.
  • Collaborating with addiction medicine specialists, OB-GYNs, and community-based organizations.

Conclusion

By incorporating evidence-based practices and prioritizing whole-person care, Arizona healthcare providers can help improve the lives of pregnant people with OUD and give their infants the best possible start in life. The SAMHSA advisory guide, which is attached below, provides valuable guidance and resources for providers caring for this vulnerable population.

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Nirvana Recovery