For women who use opioids, pregnancy is often a powerful catalyst for seeking treatment.
“It’s a time when women are least likely to experience a fatal overdose and most likely to initiate treatment for their addiction,” said Alicia Agnoli, assistant professor of family and community medicine at UC Davis Health.
Agnoli is using this window of opportunity to fight the opioid epidemic.
Integrating care for treating opioid use disorder
Over the past three years, Agnoli has seen an uptick in mothers with opioid use disorder. She is working to standardize treatments across the health system to support expectant mothers and help them deliver healthy babies.
“Treating opioid addiction is an area of growth. We are trying to be thoughtful about how we can expand access and improve the quality of care for women who use drugs in pregnancy,” she said.
Agnoli is helping to develop a 24/7 consultation service to care for hospitalized patients with substance use disorders. The response team includes physicians, toxicologists, social workers, pharmacists and other experts who can recommend treatment options for patients with drug addiction. They are also working to increase the number of substance use navigators in the emergency department from one to three. The counselors help patients access the resources they need after discharge from the hospital.
Medication-assisted treatment (MAT) for opioid use disorder
Buprenorphine is a powerful tool in the physician’s toolbox for patients who are ready to get on the road to recovery. The medication significantly reduces withdrawal symptoms and is safe to use throughout pregnancy. The medication is given to patients in pill form or as a film placed under the tongue. Patients typically notice a lessening of withdrawal symptoms within 30 to 60 minutes.
The Department of Family and Community Medicine has set a goal for all residents to be licensed to prescribe buprenorphine by graduation. Physicians must meet the X-waiver requirement to be able to treat opioid use disorder with buprenorphine, per the Drug Addiction Treatment Act (DATA) of 2000.
The department also offers cards to patients who may want to start treatment on their own terms. The card says, “I’m here to start buprenorphine.” Patients can bring the card to the UC Davis Emergency Department to start the medication-assisted treatment and receive help from a substance use navigator.
For outpatient prenatal care, patients can also be treated with methadone, which is administered at Sacramento County methadone clinics. Some patients prefer methadone because they have used it in the past or prefer to have daily visits to the clinic to receive treatment.
Helping women with opioid use disorder deliver healthy babies
Pregnant women with opioid use disorder have an increased risk of serious complications. These include preterm labor, fetal growth problems and stillbirth.
“The sooner that pregnant mothers can start treatment, the better the outcomes are for both mothers and their babies,” she said.
Agnoli is encouraged by the successes of pregnant women she has treated. Many have received help at UC Davis Health and have gone on to deliver healthy babies.
“Seeing family units in recovery is the single most rewarding part of my job,” she said.