Difference between revisions of "Expand Access to MAT/MAR for Pregnant People"
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Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]__TOC__ | Return to [[Opioid_Top-Level_Strategy_Map|Opioid Top-Level Strategy Map]] or [[ZOOM_MAP_-_Expand_Steps_to_Minimize_Opioid_Use_During_Pregnancy_or_Pregnancy_during_Opioid_Use|ZOOM MAP - Expand Steps to Minimize Opioid Use During Pregnancy or Pregnancy during Opioid Use]]__TOC__ | ||
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[[TR_-_Expand_Access_to_MAT_for_Pregnant_Women|TR - Expand Access to MAT for Pregnant Women]] | [[TR_-_Expand_Access_to_MAT_for_Pregnant_Women|TR - Expand Access to MAT for Pregnant Women]] | ||
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<br/> <br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[insert name here]</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span> | |||
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#[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [14]] | #[https://healthandjusticejournal.springeropen.com/articles/10.1186/s40352-015-0015-5 [14]] | ||
#[https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm [15]] | #[https://www.cdc.gov/mmwr/volumes/66/wr/mm6609a2.htm [15]] | ||
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[[Category:SAFE-Treatment and Recovery]] | [[Category:SAFE-Treatment and Recovery]] |
Revision as of 06:55, 11 March 2020
Background
Maintenance Therapy Drugs
Medically supervised tapering of opioids in pregnant women is associated with high relapse rates as compared to methadone maintenance.[1]
Women who need maintenance therapy drugs often struggle to get them. To get buprenorphine, they must go to one of the state's few doctors with a special license. To get methadone, they must go regularly to a clinic — in Middle Tennessee there's one in Nashville and one in Columbia. Women must often pay out of pocket. And many women of child-bearing age don't qualify for TennCare until they find themselves pregnant. That makes it difficult for an addict to access family planning or mental health preventive care before becoming pregnant.[2]
Tennessee's three managed care companies — Amerigroup, UnitedHealthcare's Medicaid subsidiary and BlueCross BlueShield's BlueCare program — are trying to reach these women earlier to ensure that more babies are born healthy. All have flagged drug-dependent babies as a major cost issue. BlueCross, for example, covered 775 such babies in 2013 [must be nationwide]. [at $50,000 each, which is a low estimate of incremental cost over a normal birth, that cost BlueCross about 38 million.] All three have launched efforts to help expectant mothers beat their addictions.[3]
Current Status
- There are often long waiting periods to get women into treatment.[4]
- Although pregnant women actually receive priority for methadone treatment, once they are not pregnant they return tot the long waiting periods and the motivation to pursue treatment may be deterred by these waits[5]
- Women often experience anxiety about what will happen if they can no longer pay for their methadone treatments[6]
- There is a need for increased grant funding to help women stay in treatment once they are enrolled[7]
- Women have misconceptions about methadone and are unclear about the treatment process[8]
- 13 states give pregnant women priority access to general programs for drug treatment.[9]
- 4 states protect pregnant women from discrimination in publicly funded programs.[10]
- 18 states consider substance abuse during pregnancy to be grounds for child abuse.[11]
Educate Medical Providers
New 2018 Clinical Guide by SAMHSA
Split Dosing to Reduce Risk
In pregnancy, split doses of methadone protect the fetus from exposure to daily cycles of peaks and troughs, which have been shown to have negative physiologic effects on the fetus.* Even high doses, when given as single daily doses, can result in fetal withdrawal distress before the next day’s dose. That may be why high doses, at times, seem to cause more cases of NAS: The fetus may be sensitized to daily episodes of withdrawal.* Some mothers, like our patient who received 270 mg daily, are ultra-rapid metabolizers; the methadone exposure for their fetuses is far more consistent and physiologic when dosing is four times a day."[14]
Methadone Clinics
- What to expect in regards to pain management
- Infant withdrawal symptoms
- CPS involvement
- Treatment approaches for withdrawing infants
- How to work with doctors and nurses to help the process go smoothly
- Advice for comforting methadone-exposed babies once they come home
Funding
Tools & Resources
TR - Expand Access to MAT for Pregnant Women
PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]
Reviewer | Date | Comments |
Sources
- ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine. ACOG committee opinion no. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012;119:1070–6
- [1]
- [2]
- [3]
- [4]
- [5]
- [6]
- [7]
- [8]
- [9]
- [10]
- [11]
- ACOG Committee on Health Care for Underserved Women; American Society of Addiction Medicine. ACOG committee opinion no. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012;119:1070–6
- [12]
- [13]
- [14]
- [15]