ORN Fall 2026 - OUD Treatment: Induction, Stabilization, and Tips for Success in the Perinatal Period-Handout - ORN Fall 2026

Handout - ORN Fall 2026 - Wessol

Pdf Summary

This presentation argues that pregnancy is an important opportunity to start medications for opioid use disorder (MOUD), not a reason to delay treatment. It uses a case example of a pregnant patient with opioid withdrawal and major social stressors to show how untreated opioid use disorder can harm both the pregnant person and the fetus, including risks of overdose, infection, preterm birth, growth restriction, neonatal opioid withdrawal syndrome (NOWS), and poor prenatal care.<br /><br />The evidence reviewed supports MOUD as the standard of care in pregnancy. Buprenorphine and methadone are both safe, effective options; naltrexone may be continued in selected patients who started it before pregnancy, but data in pregnancy are limited. Benefits of MOUD include reduced overdose risk, better prenatal engagement, improved maternal functioning, and better neonatal outcomes. The “right” medication and dose are the ones that control withdrawal and cravings, not necessarily the lowest dose.<br /><br />Treatment can begin in multiple settings: emergency departments, inpatient units, primary care/OB practices, and opioid treatment programs. The presentation highlights several initiation pathways, including standard induction, microinduction, home induction, and methadone initiation. Early initiation should not wait for a “perfect” setting.<br /><br />Practical management includes dose titration, addressing social determinants of health, and treating co-occurring medical or psychiatric conditions. Key peripartum guidance is to continue MOUD through labor, use neuraxial analgesia when possible, and use multimodal postpartum pain control. Postpartum continuation is emphasized because overdose risk is highest in the 2–12 months after delivery.<br /><br />Overall, the main message is that NOWS is expected and manageable, pregnancy should not be a barrier to MOUD, and coordinated wraparound support is essential for maternal-infant recovery.

Keywords

pregnancy

opioid use disorder

MOUD

buprenorphine

methadone

naltrexone

neonatal opioid withdrawal syndrome

prenatal care

microinduction

postpartum overdose risk