5/9/2017
SAN DIEGO, May 9, 2017 – A comprehensive outpatient clinic for opioid addicted pregnant women located at Magee-Womens Hospital of UPMC that combines office-based medication treatment, behavioral health counseling, social services and prenatal care is a cost-effective, successful strategy toward achieving sobriety, suggests a new pilot study presented today at the American Congress of Obstetricians and Gynecologists annual meeting in San Diego.
As addiction to heroin, prescription pain killers and other opioid drugs continues to be a growing national problem, opioid abuse among pregnant women is especially problematic due to the additional health risks to the developing unborn baby, said Neggin Mokhtari, M.D., a resident in obstetrics and gynecology at Magee who analyzed the new data. The biggest risk is neonatal abstinence syndrome (NAS), which is a group of problems including extreme irritability, hyperactive reflexes and high pitch cries, that often occur in newborns exposed to opiate drugs in utero.
“We do not recommend detoxification during pregnancy,” explained Mokhtari. Instead, pregnant addicted women are treated with medications—either methadone or buprenorphine—which help reduce cravings and dependency on opioids, along with pre-natal care, counseling and social support.
Since 2014, UPMC has addressed the growing epidemic with its comprehensive care program, called the Pregnancy Recovery Center (PRC) at Magee-Womens Hospital of UPMC, where patients receive care throughout their pregnancy on an outpatient basis. The coordination of services and focus on all of the addicted pregnant woman’s health needs has been found to improve clinical outcomes for the mother and baby and reduces the costs associated with caring for a newborn with NAS. To accommodate more women seeking treatment, the PRC, one of the first programs in the country to provide this combined treatment for opioid addiction as well as prenatal care, expanded to five additional locations in western Pennsylvania.
During the PRC’s first year, 50 pregnant women with opioid use disorder sought treatment from the PRC and 32 (65 percent) successfully completed the program. In the new study, Mokhtari and colleagues compared the outcomes of these 32 women to 78 pregnant women addicted to opioids and on buprenorphine who did not participate in the PRC program, but instead received care through community providers.
The researchers found that PRC patients used a significantly higher dose of buprenorphine at the time of delivery compared to the buprenorphine doses of non-PRC patients. Despite differences in dose, rates of NAS were roughly 45 percent in both groups. In addition, PRC patients had much lower hospital charges at the end of their pregnancy and during delivery than the non-PRC patients ($24,000 vs. $184,000), indicating that this comprehensive treatment approach also is cost effective.
“These findings highlight the viability and value of the PRC treatment program, which gives our patients greater autonomy since they are treated on an outpatient basis. This model of care allows us to adjust the buprenorphine dose to the patient’s needs to avoid withdrawal symptoms, ensuring the stability of the mother, without affecting the baby’s health,” explained Mokhtari.
Additional contributors to the study include: Stephanie Bobby, R.N., Judy Chang, M.D., M.P.H., Robert Gedekoh, M.D., Michael England, M.D., and Elizabeth Krans, M.D., M.Sc., all of Magee-Womens Hospital of UPMC.
