Pregnancy and Opioid Exposure

Melissa L. Godwin, LCSW

UNC School of Social Work
mgodwin@email.unc.edu
NC Division of Mental Health, Developmental
Disabilities and Substance Abuse Services

Opioids Prescribed in NC
Oxycodone

Least
Prescribed
Prescribed

Most

Fentanyl
Hydrocodone
Methadone
Morphine
Buprenorphine
Hydromorphone
Codeine
Mepheridine

The
Most
Common
Opioids
Prescrib
ed

in North
Carolina
1997 to 2010, the Federal DEA recorded
2010.
an 839% increase in sales of the
opioid
Adapted from Modarai, F. et al

oxycodone in NC

Opioid Exposed People

RX

Large availability of substance

Genetic vulnerability
Nature of substance
Opioid Use
Disorders

creates euphoria,
takes away pain
Trauma history, other
ACEs

MAT

Treatment

NC Pregnancy and Opioid Exposure

Stakeholder Workgroup
Disciplines represented include:
OB/GYNs, pediatricians, nurses, social workers, substance abuse
treatment providers, pharmacists and public health professionals.
Goals:
Education and collaboration
Identify best practice continuum of care for range of complex needs for
women who are pregnant, opioid taking and their infants.*
Develop and disseminate educational tools for providers*
Identification of services for women and their infants*
Improve collaboration of providers*

NC Pregnancy and Opioid Exposure

Stakeholder Workgroup
Goals continued
Infants
Early identification and management of infants born experiencing
Neonatal Abstinence Syndrome (NAS).*
Longitudinal research of infants born with NAS due to opioid exposure.
Policy and legislation
Propose prescribing regulations, to include informed consent requiring
education of women prior to prescribing, regarding impact on newborn
if she were to become pregnant.
Support increased use of Controlled Substance Reporting System
(CSRS) by providers
Grant funding capacity

Messaging
Workgroup members built consensus around key messages related to
opioid use in pregnancy.
Key messages were developed with a focus on
1) women of childbearing age who are taking opioids & pregnant
women with opioid dependence,
2) providers who care for these women, and
3) providers who care for opioid-exposed newborns and their
families.

NC Pregnancy and Opioid Exposure Professional Education Needs Survey

Snowball sampling targeting medical, behavioral health,

justice and child welfare professionals
909 respondents completed, from 93 of 100 NC counties
Accurate knowledge of respondents was uneven

NC Pregnancy and Opioid Exposure

Professional Education Needs Survey
Knowledge of Professionals
17%

Genetic vulnerability for addiction

28%
35%
37%
45%
47%
48%
52%
53%

Postpartum management of medication assisted treatment

Breastfeeding and methadone
Use of opioids in pregnancy can result in child abuse conviction
NAS is treatable
Abstinence vs. medication assisted treatment
Detox vs medication assisted treatment during pregnancy
Pain management and pregnancy
Cause of NAS
0%

10%

20%

30%

40%

50%

60%

% Correct

N=909

Pregnancy and Opioid: Guidance for North

Carolina

Adapted from existing materials from Vermont

Interdisciplinary stakeholder input
Intended for broad audience of professionals
Electronically available ncpoep.org

 NC Pregnancy and Opioid Exposure Guidance Document

Messaging for multiple audiences
Service locator
Brief Intervention video
Introduction video to Perinatal Substance Use Specialist and
related programs
Related resources and training events
ncpoep.org

Resources
PMH Care Pathway on the Management of Substance Use in
Pregnancy
https://www.communitycarenc.org/population-management/pr
egnancy-home/pmh-pathways/pmh-care-pathways-management-s
ubstance-use-pregnan
/
NC SBIRT
www.sbirtnc.org
NC Perinatal, Maternal and CASAWORKS for Families
http://ncpregnancy.org/resource-directory/treatment/