Issue link: http://accesshealth.uberflip.com/i/1398865
PAGE 21 August Issue 2021 In addition to substance use, pregnant people should also be screened for possible mental health issues, HIV, hepatitis B and C (which can cooccur with substance use through shared needles), and domestic violence. A hospital survey found that although 97% do a universal screening of pregnant women, only 6% use a specific validated screening tool. Dr. Weaver recommends the following instruments for identifying women at risk and making recommendations and diagnoses to initiate treatment: ● Drug Abuse Screening Test (DAST-10) ● 4Ps ● CRAFFT for adolescents ● NIDA Quick Screen While it may be prudent to test the mother and/or newborn for drug use or SUD, it's important to note that drug tests do not indicate the details of what substance she has been using, the amount, the frequency of use, or the route administered. Dr. Weaver said positive drug tests are not indicative of an SUD diagnosis. "There may be other reasons why mom may have various substances on board that are prescribed for her appropriately or because she's in treatment." "A positive test result does not provide a result of parenting ability and should not be used to determine that in any way. It is simply a data point used together with the big picture to determine an appropriate course of action to help a pregnant woman and identify the conditions she may need testing for." Testing should never be done without the woman's knowledge and requires informed consent for bodily fluid tests. Providers should discuss the importance of gathering this information to best determine a course of action to improve her total health while respecting her autonomy. Treatments for Substance Use During and After Pregnancy When approaching treatment options for pregnant or childbearing-able people, it's important to explain the complex nature of addiction and validate that the person is not totally responsible for acquiring it. "We recognize that addiction is a brain disease, and there are a lot of factors involved," said Dr. Weaver. "No one wants to develop SUD, but through a series of choices, they find themselves in a situation that is very difficult to get out of." While the patient is not responsible for their addiction, they are responsible for their own recovery and continuing to make healthy choices. Addiction is treatable; it's critical to remain optimistic about the ability to overcome the disease and stressful outcomes. Providers should remind their patient of the effects substances can have on them and their unborn child. It's also helpful to point out how improving their overall health can improve the social factors affecting their life as well. Unfortunately, women may be wary of acknowledging that they have a substance use problem out of fear of legal consequences such as loss of custody. Reporting requirements can be very confusing and may put women in a difficult position at times. Providers should inform patients of their legal obligation in terms of reporting positive drug tests and deciding whether to enter treatment. Medication for Addiction Treatment (MAT) is the standard of care for pregnant women with OUD. Withdrawal of MAT during pregnancy is not recommended as it can lead to high relapse rates and health risks to the fetus. MAT is recommended through and after delivery, and once the woman is more stable, she can decide if she wants to continue or end treatment. Initial treatment for NAS includes supportive swaddling, frequent feeding, and IV fluids. Supportive approaches are needed to treat hyperactivity, irritability, and difficulty latching during breastfeeding. "When a baby is born with NAS, they experience a withdrawal symptom that is a little bit different from an adult, as well as the fact that a newborn can't tell us what they're going through," said Dr. Weaver. High-pitched cries and other symptoms of distress are often treated with pharmacotherapy, including sedative- hypnotic opioids or a tincture. Breastfeeding is encouraged as it promotes bonding, optimal nutrition, and passive immunity. Improving maternal health is a high priority, so entry into programs such as these are often more rapid than traditional health appointments. Maternal and fetal health stabilization is the ultimate goal, according to Dr. Weaver. "This allows her to fully participate in her substance use treatment and her mental health care, obstetrical plan of care, and other social services she needs." "If we intervene effectively on pregnant women or women of child-bearing potential, we can have a significant impact on this cause and definitely make an improvement from a public health standpoint." Learn more about HRSA's RCORP and NAS programs by watching the recorded webinar. Resources for people with substance use concerns include: ● SAMHSA treatment locator website: www.findtreatment.gov ● American Society of Addiction Medicine: www.asam.org ● American Academy of Addiction Psychiatry: www.aaap.org ● National Association for Alcohol and Drug Abuse Counselors: www.naadac.org (© Tyler Olsen - stock.adobe.com)