Opioid and Substance Use Disorders

The DSM-5 diagnostic criteria for substance use disorder include a pathologic pattern of behaviors related to use of a substance that leads to (1) impaired control of use of the substance; (2) social problems such as failure to fulfill obligations at home, school, and work; (3) risky use; and (4) symptoms secondary to the pharmacologic properties of the substance such as tolerance and withdrawal (American Psychiatric Association. Chapter: substance related and addictive disorders. In: Diagnostic and statistical manual of mental disorders, 5th edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing, 2022). Substance use disorders in pregnancy are common and associated with significant maternal and fetal morbidity and mortality. According to the 2021 National Survey on Drug Use and Health, 19.6% of pregnant women used illicit drugs, alcohol, or tobacco products within the past month (SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health. https://www.samhsa.gov/data/report/2021-nsduh-detailed-tables . Accessed 20 Feb 2023, 2021). Pregnant patients with substance use disorder represent all socioeconomic demographics, races, and ethnicities and live in rural, urban, and suburban settings. Substance use disorders encompass ten classes of substances: alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, anxiolytic sedative hypnotics, stimulants, tobacco, and other (or unknown) substances. American Psychiatric Association [APA] screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to identify and treat substance use disorders in pregnancy that is associated with improved maternal and fetal outcomes (Committee Opinion No. 711. Obstet Gynecol. 130:e81–94, 2017). Pregnant patients with substance use disorders may experience discrimination from physicians and healthcare providers, social stigma, and criminalization (The American College of Obstetricians and Gynecologists. Statements of policy: opposition to criminalization of individuals during pregnancy and the postpartum period. Approved by the Board of Directors, December 2020. https://www.acog.org/clinical-information/policy-and-position-statements/statements-of-policy/2020/opposition-criminalization-of-individuals-pregnancy-and-postpartum-period ).