ASAM Provider Guide

National Practice Guideline for the Treatment of Opioid Use Disorder - 2020 Update

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22 Special Populations Pregnant Women Î NEW – The first priority in evaluating pregnant women for OUD should be to identify emergent or urgent medical conditions that require immediate referral for clinical evaluation. Î Treatment with methadone or buprenorphine is recommended and should be initiated as early as possible during pregnancy. See the buprenorphine section for guidance on induction. Î MAJOR REVISION – Pregnant women who are physically dependent on opioids should receive treatment using methadone or buprenorphine rather than withdrawal management or psychosocial treatment alone. Î MAJOR REVISION – A medical examination and psychosocial assessment are recommended when evaluating pregnant women for OUD. • However, completion of all assessments should not delay or preclude initiating pharmacotherapy for OUD. • If not completed before initiating treatment, assessments should be completed as soon as possible thereafter. Î Obstetricians, gynecologists, and other healthcare providers that care for pregnant women should be alert to signs and symptoms of OUD. • Pregnant women with OUD are more likely to seek prenatal care late in pregnancy, miss appointments, experience poor weight gain, or exhibit signs of withdrawal or intoxication. Î MAJOR REVISION – The psychosocial needs of pregnant women being treated for OUD should be assessed, and patients should be offered or referred to psychosocial treatment based on their individual needs. • A woman's decision to decline psychosocial treatment or the absence of available psychosocial treatment should not preclude or delay pharmacological treatment, with appropriate medication management, during pregnancy. • Motivational interviewing or enhancement can be used to encourage patients to engage in psychosocial treatment services appropriate for addressing their individual needs. Î Counseling and testing for HIV should be provided in accordance with state law. • Tests for hepatitis A, B and C and liver function are also suggested. • TB screening and testing, if appropriate. • Hepatitis A and B vaccination is recommended for those whose hepatitis serolog y is negative.

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