21
Figure 2. Pregnancy
History
• Concomitant medical conditions
(hepatitis, HIV, TB, acute trauma)
• Alcohol
• Other substance abuse, including
tobacco
Laboratory
• CBC, LFTs,
• Hepatitis A, B & C
• HIV, STIs
• Confirmatory urine testing
Social and Environmental Factors
• Food insecurity
• Housing
• Transportation challenges
• Domestic violence
• Significant mental health issues
Encourage breastfeeding
(unless contraindicated)
Naltrexone
• Low relapse risk:
consider discontinuation
• Relapse risk:
consider switch to
buprenroprhine or
methadone
• Continue NTR only
after discussing lack of
evidence on safety and
obtaining consent
LEGEND
Diagnosis/Evaluation
Treatment
Results, Notes, Status
Important Comments
Buprenorphine
• Consider Level 3 or 4
to initiate treatment
(especially in 3
rd
trimester)
• Dose increases may
be needed
• Consider split dosing
Recommend prenatal care
and dating ultrasound
• Abdominal pain (could be
preterm labor)
• Bleeding
• High blood pressure
• Significant mental health issues
• Domestic violence
Identify and refer urgent problems
• Hepatitis A & B vaccines (if seronegative)
• HIV and TB counseling
• Psychosocial treatment
First Line Treatment
Methadone
• Start early
• Consider Level 4 to
initiate
• Dose increases may be
needed
• Consider splitting the
dose at least in half
