Substance use disorder as a chronic disease


At the 2023 ACOG Annual Clinical & Scientific Meeting, Caitlin Martin, MD, discussed the concerning rise in substance use mortalities and maternal mortalities.

Caitlin Martin, MD:

Hi, my name is Caitlin Martin. I'm at Virginia Commonwealth University in Richmond, Virginia. I am a board-certified OB/GYN as well as addiction medicine subspecialist.

What was your session at ACOG about?


Yes, so yesterday I had the privilege of being able to speak at ACOG on substance use disorders as a chronic disease, and talk about some actionable evidence based tools that us as OB/GYN providers and other health care professionals can do to help address the overdose crisis that's occurring concurrently with the increasing maternal mortality crisis in our country.

What is the significance of this topic?


So, substance use disorders are extremely prevalent and have continued to become even more prevalent and causing increasing morbidity and mortality throughout the last decade or so. And then last year, the CDC came out with a new report showing that the actually the number one cause of pregnancy related deaths, and during pregnancy for the 1-year postpartum period, are mental health conditions, largely driven by overdose related deaths in the postpartum period, mainly in the 6 to 12 months after pregnancy. And so, we're just at this time where with increasing overdose deaths and increasing disparity that we're seeing by race and ethnicity due to structural systemic factors related to racism, it's just at the time where OB/GYN providers, and all health care professionals, we just can't sit on our hands anymore, we need to all do something to address this crisis that's going on in our country.

What are 3 takeaways from your presentation?


That is a good question. I had a few takeaways. I had 4. So, the first one was what I just talked about that this epidemiologically, this is an increasing crisis that's occurring at the same time as increasing maternal mortality crisis. And we're seeing these stark disparities by race and ethnicity, largely for pregnant people and postpartum people. The second thing we went over was about addiction, and its pathophysiology as a chronic disease. Historically, because of the war on drugs, we've historically thought about addiction as being something separate from the general traditional health care model. But now we really need to take a public health approach by addressing substance use disorder as a chronic disease, just like diabetes, hypertension. So, we spent a lot of time yesterday in the talk, talking about the neurobiological basis of this chronic disease of addiction. And then lastly, we talked about some evidence based actionable tools that all of us can start bringing to the exam room tomorrow. I had a patient with lived experience and join me to talk about these things. One of the things we talked about was the expert model, so screening, brief Intervention, referral to treatment. So, we talked about validated screening tools, for example, not drug testing that can be used to screen patients for high low or medium risk for substance use disorder. We talked about brief interventions, which generally are going to be most importantly compassionate and non-judgmental discussions with your patients about their substance use. And then lastly, we talked about treatment. So, evidence-based treatments, such as medications that are FDA approved for alcohol and opioid use disorders, we really need to increase the utilization of those and decrease the stigma that's associated with these lifesaving treatments. For example, medications for opioid use disorder, when they're included in opioid use disorder treatments, reduce mortality risks on the population level by over 50%. And as an OBG/YN provider, I can't think of another medication I've ever prescribed that has such a robust benefit to my patients, families and society.

How has the conference been for you?


Oh, I really am really enjoying ACOG. First of all, it's lovely to be able to connect with colleagues from around the country. And then secondly, I can tell yesterday was great, it was really great to be able to give my speech, give my talk with my co-presenter with lived experience. And I love the interest and just eagerness that people are showing to learn more about addiction and see what they can do to not be sitting on their hands anymore. And it was very invigorating to see.

Is there anything you would like to add?


So all I want to add lastly, is that if you're ever scared about addressing substance use disorders, if you’re thinking this this quote, unquote, you know, open up a bag of worms are a can of worms in your exam room, there are ways to do it that you can still do it in your 15 minute visit, for example that you have with the patient. And so, I would encourage you to just take some time to do some trainings, listen to a talk, reach out to a colleague. I went over some resources in my talk yesterday, even a warm line that we have by providers that are standing by to answer questions that people have on substance use disorders, including during pregnancy. But taking those small first steps can make a huge difference and I would highly encourage you to do so.

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