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 explains why and how to initiate medications for opioid use disorder (MOUD) during pregnancy. It emphasizes that pregnancy is an opportunity, not a barrier, to start treatment. Untreated opioid use disorder (OUD) can harm both pregnant people and infants, increasing risks such as overdose, infection, preterm birth, neonatal opioid withdrawal syndrome (NOWS), and poor maternal engagement in care.<br /><br />The talk reviews stigma reduction, universal screening, and the importance of nonjudgmental language and consent-based toxicology testing. It highlights that MOUD improves outcomes, including reduced overdose risk, better prenatal engagement, lower preterm birth rates, and improved infant size at birth.<br /><br />The main medications discussed are methadone, buprenorphine, and naltrexone. Buprenorphine is presented as first-line in many settings because it can be prescribed outpatient and has slightly lower NOWS severity; methadone is also effective and may improve retention but requires an opioid treatment program; naltrexone has limited pregnancy safety data and is generally continued only if started before pregnancy. The presentation stresses that treatment can start in many settings—emergency departments, hospitals, primary care, obstetric clinics, or OTPs—using approaches such as standard induction, microinduction, home induction, inpatient induction, or methadone titration.<br /><br />Practical management guidance includes adjusting doses to control withdrawal and cravings, addressing social determinants of health, and treating co-occurring medical or psychiatric symptoms. It also reviews labor, delivery, and postpartum care, noting that MOUD should generally be continued through labor and postpartum, with multimodal pain control and additional opioids when needed after cesarean delivery.<br /><br />A key message is that NOWS is expected and manageable and should not prevent MOUD initiation. The postpartum period carries heightened overdose risk, so ongoing treatment, naloxone access, pediatric follow-up, and wraparound family supports are essential.

Keywords

medications for opioid use disorder

MOUD

pregnancy

opioid use disorder

buprenorphine

methadone

naltrexone

neonatal opioid withdrawal syndrome

prenatal care

postpartum overdose risk