At the 2023 ACOG Annual Clinical & Scientific Meeting, details on substance use disorder were provided, including methods of treatment and the screening process for women.
Substance use disorder has a significant impact on women’s health, according to data presented by Caitlin E. Martin, MD, MPH, FACOG, FASAM, at the 2023 American Academy of Obstetricians and Gynecologists Annual Clinical & Scientific Meeting.
Women, especially those who are Black or post partum, die more often from substance use than traditional medical causes. A significant increase in substance use-related deaths was observed during the COVID-19 pandemic, with 108,712 deaths from overdose in the 12 months before November 2022 reported in the United States, compared to 53,110 reported in November 2015.
Significant disparities have also been reported because of systemic racism intersecting with factors related to substance use. Additionally, opioid-related deaths based on race have seen a significant shift.
The maternal mortality crisis and overdose crisis have also intersected, with deaths from mental health conditions largely driven by postpartum overdose being the main source of maternal mortality.
There are multiple biopsychosocial factors impacting substance use disorder, making it more than a “moral failure” or “choice.” Addiction is defined as, “abrain-centered condition whose symptoms are behaviors salient feature: continued use despite adverse consequences.”
Addiction is linked to interactions between genetics, brain circuits, life experiences, and one’s environment.Despite adverse outcomes, individuals with addiction continue to use substances compulsively. However, prevention efforts and treatment approaches see similar rates of success as those for other chronic diseases.
Evidence-based medicine is necessary to treat addiction in clinical practices. Practitioners should follow SBIRT, meaning Screening, Brief Intervention, Referral to Treatment. Patients should receive universal screening, involving a brief questionnaire, an interview, and computer-assisted assessment.
Low-risk patients are those with no past or current substance use, or with low levels of use which were halted before pregnancy or immediately upon realizing pregnancy. Medium-risk patients are those with high use in the past who stopped use late in pregnancy and had continued low levels of use. High risk patients are those who meet the criteria for substance use disorder.
Patients at low risk should receive brief advice and a written pamphlet, while those at moderate risk should receive a brief intervention, motivational interviewing, and frequent follow-up visits with a provider. Patients at high risk should be referred to specialized substance use disorder treatment and have frequent follow-up visits with a provider.
When screening for substance use disorder in pregnant individuals, providers should ask the following questions: Have you ever smoked marijuana? In the month before you knew you were pregnant, how many beers, how much wine, or how much liquor did you drink? Have you ever believed that you needed to cut down on your drug or alcohol use?
Patients should also be asked about the past 12-month use of any tobacco product, 4 or more alcoholic drinks in a day, drugs such as marijuana, crack, or cocaine, and prescription medicine for the feeling, more than prescribed, or not prescribed.
When conducting brief interventions after screening, assessments and tenants of motivational interviewing should occur. Treatment initiation should include FDA approved products, provided alongside visits to medical providers.
According to a study published in JAMA Psychiatry, mortality risk is reduced by over half from buprenorphine (Buprenex; Mallinckrodt Pharmaceuticals) or methadone (Methadose; Rosemont Pharmaceuticals) treatment. Buprenorphine can be started in an inpatient or outpatient clinic, or at home, with 2 mg to 4 mg prn initialized for moderate withdrawal symptoms.
Action must be taken now to destigmatize addiction. The words of physician and clinicians are especially valuable, and they can use first-person language to reduce the stigma. Proper terms should be used to show compassion and care. As addiction is a chronic disease, it should be treated like one, with a final goal of recovery.
Martin CE. Addressing substance use disorder as the chronic disease it is: How to apply actionable, evidence- based tools. Presented at: 2023 Annual Clinical & Scientific Meeting. May 19-21. Baltimore, Maryland.