Welcome to My New Health Policy Blog

My name is Brittany Schulte. I am currently an Arizona State University student in the Women’s Health Nurse Practitioner (WHNP). I will graduate with my Doctorate of Nursing Practice (DNP) in May 2020. I am writing this blog for a Healthcare Policy & Innovation class. I have been a nurse in women’s health for many years. I am passionate about improving the care of pregnant and postpartum women in recovery from substance use. I currently work with this population in my current employment. I find this work to be both challenging and rewarding. There is room for improvements to the continuum of care that is currently available. Through this blog, I hope to bring increased awareness to improvements that could be made to improve care to women in recovery and their babies, hence the idea of family centered care.

Family centered treatment programs for pregnant and postpartum women in the state of Arizona.
The opioid crisis continues to have a significant impact in communities within the state of Arizona. Women who are using opioids may discover they are pregnant and find that this gives them the inspiration they need to seek treatment. Women who are pregnant and using opioids are eligible to begin treatment with medication assisted treatment (MAT) with either methadone or buprenorphine. These medications should be used in conjunction with counseling and treatment programs. They are safe to use during pregnancy and are recommended by experts in the care of pregnant women and newborns. These medications can help reduce pregnancy complications and can help the mother to be focus on prenatal health and her recovery. Both medications are safe to use while breastfeeding. Breastfeeding has many benefits to both mother and baby. Breastfeeding is not considered safe for women with HIV, certain medications that may be contraindicated, or with continued use of illicit substances.
Women may face difficulty beginning treatment during pregnancy due to lack of treatment facilities that specialize in the care of pregnant and postpartum women. Substance use during pregnancy requires providers to report to the Arizona Department of Child Safety (DCS). This may cause anxiety due to the fear of having the child removed from her custody. It may also lead to difficulty bonding with the baby during the pregnancy. Additionally, the postpartum period is a difficult time in the recovery process due to an increase in stress and emotions. Counseling and treatment for women in recovery during the postpartum period is just as important as during the pregnancy.
Women in a few Arizona counties including Maricopa and Yuma who give birth to a baby with NAS can be referred by DCS to a program called Substance Exposed Newborn Safe Environment (SENSE). SENSE was developed in 2006 to provide in-home care, with as many as five in-home visits a week, and weekly email checkups between parents and service providers.
Ten states, not including Arizona, have partnered with the Centers for Medicare and Medicaid Services (CMS) to begin a program that focuses on improving care to pregnant and postpartum women with opioid use disorder that are in the Medicaid program. The aim of the program, called the Maternal Opioid Misuse (MOM) Model, is to improve delivery of care to this vulnerable population through state driven changes to medical care. In theory care will be less fragmented and will help to improve quality of care while decreasing health care costs. The MOM model will be implemented in 2020, and results will be evaluated over a five-year period.
An increase in the number of treatment facilities that specialize in the care of pregnant and postpartum women in the state of Arizona, could help to increase the number of women who remain successful in their recovery following the birth of their child. Residential treatment facilities for pregnant and postpartum women help to guide women into parenting while continuing to offer support for recovery. Mothers and babies are not separated, and the babies are monitored for symptoms of neonatal abstinence syndrome (NAS). Mothers not only learn parenting skills, they learn skills of how to care for and treat their baby during symptoms of NAS.
Women’s Health Nurse practitioners (WHNP) are positioned to partner in providing supportive health care services to women during their pregnancy and postpartum period. Providing care in a holistic and professional manner can help to decrease tensions and mistrust. Active involvement in development of policies at the state level that will increase coordination of care services and develop additional facilities in the state to provide care while supporting recovery for pregnant and postpartum women with opioid use disorder. This will help to improve long term health for both the woman and her baby.

References
American College of Obstetricians & Gynecologists. (2017). ACOG committee opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics & Gynecology, 130, e81-94.
Arizona Health Care Cost Containment Services. (2020). Pregnancy and opioids. Retrieved from https://www.azahcccs.gov/Members/BehavioralHealthServices/OpioidUseDisorderAndTreatment/Pregnancy_And_Opioids.html
Center for Medicare & Medicaid Services. (2019). Maternal opioid misuse (MOM) model. Retrieved from https://innovation.cms.gov/initiatives/maternal-opioid-misuse-model/
Cleveland, L.M. (2016). Breastfeeding recommendations for women who receive medication-assisted treatment for opioid use disorders: AWHONN practice brief No. 4. Journal of Obstetric, Gynecologic, & Neonatal Nurses, 45(4), 574-576.
Ecker, J., Abuhamad, A., Hill, W., Bailit, J., Bateman, B. T., Berghella, V., …Yonkers, K. A. (2019). Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. American Journal of Obstetrics & Gynecology. 221(1), B5-B28.
Polakoff, J. (2017). Pregnant women, newborns on front lines of Arizona’s opioid epidemic. The Chronicle of Social Change. Retrieved from chronicleofsocialchange.org/analysis/pregnant-women-newborns-on-front-lines-of-arizonas-opioid-epidemic/26572
Reece-Stremtan, S., Marinelli, K. A., & the American Academy of Breastfeeding. (2015). ABM clinical protocol No. 21: Guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeeding Medicine, 10(3), 135-141.
Smith, K. & Lipari, R. (2017). Women of childbearing age and opioids. The CBHSQ Report, January 17, 2017. Retrieved from Substance Abuse and Mental Health Services Administration Online. Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2724/ShortReport-2724

Blog #2: Ethical Considerations In Policy Making: With a Focus on the Development of Policies Dealing with Women with Opiate Use Disorder
Merriam-Webster (2020) defines ethics as “the discipline dealing with what is good and bad and with moral duty and obligation〖^2〗.” Policies are decisions made with the intent of directing actions and behaviors within a population 〖^5〗. The idea of ethical policies implies the idea that the right thing is then being done for a specific population within a community. Policies are often designed with consideration of protecting rights and freedoms of special populations, as well as rights and freedoms of the majority. Public policy is often a reflection of attitudes and values of the community with a focus on special populations or issues that may require protection 〖^7〗.
Policy development follows six predictable steps 〖^7〗. Step one involves setting the agenda. In the initial step, the issue is identified and brought to attention. In simple terms, what is the problem? Step two is formation of the policy. In this step, ideas are formulated for addressing the issue. Simply, what should we do about it? Step three involves bringing the policy forward for formal approval. Step four involves putting legislation into effect. Step five involves evaluation. Is the solution appropriate? Step six involves evaluation of changes that may improve the policy or deciding that the policy is not effective or appropriate and terminating it.
Pregnant women with opioid use (OUD) are considered a special population. They are at increased risk for exposure to violence, infectious disease, and may avoid health care visits for fear of repercussions. They are at risk for isolation and prejudices both by members of the community and healthcare workers. OUD is a chronic health condition characterized by tolerance, craving, the inability to control use, and continued use despite adverse consequences 〖^4,6〗. Women who begin misusing prescription opioids are at increased risk for escalating use to heroin due to costs of prescription opioids, increased regulation of opioid prescriptions, and availability of heroin. Within the state of Arizona, all schedule II prescriptions will be required to be e-prescribed to decrease overprescribing and doctor shopping.〖^1〗 Limiting prescribing may help to limit exposure for future prescriptions but may contribute to issues for those who are already misusing. Pregnant women may choose this time to ask for help for OUD, and increased access to evidence based programs that specialize in their recovery.
Potential ethical dilemmas should be considered as policies are developed. Policy development should focus on increased access to treatment programs, with a priority focus on pregnant women. Policy focus needs to come from both the state and eventually the federal level. A few states in the nation have policies that focus on prosecution and punishment of mothers with OUD 〖^3,4〗. This has led to fear of prosecution and has increased barriers to care. The American Academy of Nursing (2019) published a position statement encouraging the development of evidence based therapeutic treatment interventions for pregnant and parenting women versus one of reactive punishment-based methods 〖^3〗. Policies supporting both improvements to available care and increasing access for pregnant women with OUD needs the support of health care practitioners that specialize both in the care of pregnant women and addiction medicine. Models of care at the state level developed with the support of health care practitioners will help to guide improvements to long-term health and wellness in women in recovery from OUD and their children.
References

Arizona Department of Health & Human Services (2020). Opioid Epidemic. Retrieved from https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/index.php
Ethics (2020). In Merriam-Websters Online dictionary. (2020). Retrieved from https://www.merriam-webster.com/dictionary/ethic
Jessup, M. A., Oerther, S. E., Gance-Cleveland, B., Cleveland, L. M., Czubaruk, K. M., Byrne, M. W., D’Apolito, K., Adams, S. M., Braxter, B. J., & Martinez-Rogers, N. (2019). Pregnant and parenting women with a substance use disorder: Actions and policy for enduring therapeutic practice. Nursing Outlook. 67 (2019), 199-204.
Krans, E. E. & Patrick, S. W. (2016). Opioid use disorder in pregnancy: Health policy and practice in the midst of an epidemic. Obstetrics & Gynecology. 128 (1), 4-10.
Longest, B. B. Jr. (2010). Health policymaking in the United States, 5th ed. Chicago, IL: Health Administration Press.
Rizk, A. H., Simonsen, S. E., Roberts, L., Taylor-Swanson, L., Lemoine, J. B., & Smid, M. (2019). Maternity care for pregnant women with opioid use disorder: a review. Journal of Midwifery & Women’s Health. 64 (2019), 532-544.
Switzer, J. V. (1994). Disabled policymaking/disabled policy. In Disabled rights: American disability policy and the fight for equality (pp.12-29). Washington DC: Georgetown University Press.

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Blog Post: Week 5

Discuss the historical & contemporary role of institutions & actors as well as the relevant statutory & regulatory mechanisms related to opioid use in pregnant and parenting women.

Advocacy and activism are often used to convey the same ideal. Both are important in impacting social and political changes (Patton, Zalon, & Ludwick, 2019). Understanding the difference between these ideas helps to better understand how each one impacts change. Advocacy is support of a cause, while activism utilizes strategies directed at impacting an outcome. Examples of advocacy include public speaking to educate on a topic, media campaigns, petitions, or surveys. Examples of activism include letter writing, picketing, rallies, or marches. The nursing profession has a proud and strong history of advocates including Florence Nightingale, Lillian Wald, Dorthea Dix, Margaret Sanger, and Lavinia Dock. These women have spoken up to improve health disparities and social injustices and improve both the profession of nursing and patient outcomes.

It is important to understand the importance of collaboration in advocating for policy changes (Longest, 2010; Patton, Zalon, & Ludwick, 2019). Collaborating with not only other nurses and healthcare providers, but also community members and stakeholders can help bring increased attention and focus to the need to improve policies. I had the opportunity to be a part of the March of Dimes Lobby Day at the Arizona State Capital on February 11, 2020. Providers, nurses, community members, and politicians came together to advocate for improvements in the care of maternal and infant health. None of the proposed bills were specific to maternal opioid use disorders. However, SB 1290 proposes to establish a Maternal Mental Health Advisory Committee to recommend treatments and improvements for treating perinatal mood and anxiety disorders in a report to the legislature by December 31, 2021 (March of Dimes [MOD], 2020). Addressing improvements to identification, treatment, and support of perinatal mood disorders is important for all women, including women with opioid use disorder, to improve outcomes. SB 1392 proposes to extend SOBRA coverage for postpartum women for one year. Many women lose their healthcare coverage in the postpartum period after day 56 due to changes in income eligibility requirements.

Currently in Arizona, misusing substances during pregnancy is considered child abuse and requires mandatory reporting to Child Welfare Services (Guttmacher, 2020). However, women in the state of Arizona are considered a priority for entrance into treatment programs. There needs to be an increase in treatment programs within the state that specialize in treating pregnant and postpartum women. The Society of Maternal Fetal Medicine (SMFM), the American College of Obstetricians and Gynecologists (ACOG), and the American Society of Addiction Medicine (ASAM), came together to propose improvements in care of women with substance use disorders during their pregnancy (Ecker et.al., 2019). They acknowledge the need for improvements to care. Providers must be aware of potential social and legal consequences (ACOG, 2017; Ecker et al., 2019). ACOG recommends providers actively advocate for improvements to care and for improvements in policies that support family centered treatment not separation based on substance use alone (2017).

I had the opportunity to interview Tara Sundem. Tara is a Neonatal Nurse Practitioner who advocates for improvements to care for pregnant and parenting women recovering from opioid use disorder. She is a co-founder of the Hushabye Nursery. The Hushabye Nursery is set to open later in 2020 and will be an extension of the HOPPE (Hushabye Opioid Pregnancy Preparation & Empowerment) program. Regarding the importance of the role of nurse practitioners in impacting changes in the care of women in recovery she stated, “ they can help to decrease barriers, educate, and speak to people in positions to impact change. These women know that they made bad choices, they don’t need us to tell them that. Instead, we need to offer support and education to help them in their recovery and develop parenting skills.” Actively advocating for improvements in care to women can help lead to improvements in outcomes for women and their families.

References

American College of Obstetricians & Gynecologists. (2017). ACOG committee opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics & Gynecology, 130, e81-94.

Ecker, J., Abuhamad, A., Hill, W., Bailit, J., Bateman, B. T., Berghella, V., …Yonkers, K. A. (2019). Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine. American Journal of Obstetrics & Gynecology. 221(1), B5-B28.

Guttmacher Institute. (2020). State laws and policies: Substance use during pregnancy. Retrieved from: https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy

March of Dimes. (2020). Taking care of Arizona moms and babies: 2020 bill package to improve pregnancy outcomes and maternal and infant health. Retrieved from Marchofdimes.org

Patton, R. M., Zalon, M. L., & Ludwick, R. (2019). Nurses making policy: From bedside to boardroom (2^nd ed.). New York, NY: Springer.

Week 7: Blog Post

Influence of the Public Sector

Health care reform requires a continual cycle of planning, policy-making, implementing, and evaluation of changes. Health care reform can be impacted by numerous factors including opinions in the public sector. The triple aim of health care involves improving population health, decreasing costs, and improving patient experiences.

Improving population health requires acknowledgment of existing health disparities and finding ways to better address those. Public sector influence on health care policies is often viewed through the lens of social media which impacts traditional media. Social media does not follow traditional patterns of reporting ethics and portrayals of groups within social media simultaneously reflect and influence opinions within the public sector. Information relayed may not necessarily be evidence-based or factual, and misinformation spreads quickly through social media platforms. Opinions of the public can also be shaped by portrayals within movies and television shows. Characters that are portrayed as sympathetic and struggling pull on heartstrings more than characters that demonstrate purposeful criminal behaviors. Think of how women with substance abuse issues are portrayed in the media. Does this conjure up feelings of sympathy or anger? (McDonough, 2014; Patton, Zalon, & Ludwick, 2019).

Arizona is not one of the states that specifically criminalize drug use during pregnancy, however, a pregnant woman in possession of drugs can be charged with drug possession charges and face prosecution. Arizona does have a policy of mandatory reporting. Mandatory reporting has not demonstrated a significant impact on rates of NAS within the state. Reporting agencies may be willing to initiate conversations regarding plans for the future. Factors that impact treatment access for pregnant women include insurance coverage, gestational age at presentation to treatment, and treatment modalities. Policies promoting treatment for substance use disorder during pregnancy help to work towards improving outcomes of these mothers and their babies. Policies that are aimed at improving overall healthcare for pregnant and postpartum women will also help to improve outcomes for women with substance abuse issues (Faherty et al., 2019; Hand, Short, & Abatemarco, 2017).

Arizona SB 1290 establishes a Maternal Mental Health Advisory Committee to recommend improvements in both screening and treating maternal mental health disorders. While this bill does not primarily impact pregnant women with a substance use disorder, it promotes awareness of the necessity for addressing mood and anxiety disorders using evidence-based, trauma-sensitive therapies. The advisory committee will be comprised of experts in the care of pregnant women and newborns. Recognition of maternal mental health as a priority in the state will improve outcomes for mothers and their babies (S. B. 1290, 2020).

Currently, many pregnant women with substance use disorder are covered under Medicaid. Medicaid covers women who are pregnant and up to 6 weeks postpartum. After the 6 weeks postpartum, coverage is lost to many women once the income level to retain Medicaid coverage raises. This loss of coverage impacts the ability of many women to continue treatment and receiving care for additional chronic health issues (Longest, 2010).

Improvements in care for women with substance use disorders begins with the development of evidence-based standardized treatment, improvements in coverage available for treatment in the postpartum period, and a cohesive collaboration between providers, public health, social work, and case management focused on improving outcomes for individuals and this population. Support of the public sector can be improved through improved positive media attention and education about existing health disparities that need to be addressed to improve long-term health outcomes for mothers and their babies.

Faherty, L. J., Kranz, A. M., Russell-Fritch, J., Patrick, S. W., Cantor, J., & Stein, B. D. (2019). Association of punitive and reporting state policies related to substance use in pregnancy with rates of neonatal abstinence syndrome. JAMA Network Open. 2 (11), 1-12. Doi: :10.1001/jamanetworkopen.2019.14078

Hand, D. J., Short, V. L., & Abatemarco, D. J. (2017). Substance use, treatment, and demographic characteristics of pregnant women entering treatment for opioid use disorder differ by United States census region. Journal of Substance Abuse Treatment. 76 (2017), 58-63. Doi: 10.1016/j.jsat.2017.01.011

Longest, B. B. Jr. (2010). Health policymaking in the United States (5th ed.).

Chicago, IL: Health Administration Press.

McDonough, J. E. (2014). Health system reform in the United States. International Journal of Health Policy Management. 2014 (2), 1-4.

Patton, R. M., Zalon, M. L., & Ludwick, R. (2015). Nurses making policy: From bedside to boardroom (2nd ed.). New York, NY: Springer.

S. B. 1290, 2020 Fifty-fourth Legislature, Second Reg. Sess. (Ariz. 2020).

Week 9 Blog Post:

Impact of Private Sector Innovations on Policy Advancements in MAT

It is important to understand that the treatment of opioid use disorder (OUD) is a complex process and requires both a collaborative approach to care, as well as support (American College of Obstetricians and Gynecologists [ACOG], 2017, Ecker et al., 2019). The medications that are approved for medication assisted treatment (MAT) during pregnancy, methadone and buprenorphine, are not intended to replace the previous opiate of choice. The medications alone are not sufficient treatment. They are a part of treatment that allows for participation in counseling and behavioral interventions that must be an integral part of the MAT process in order for recovery to be achieved.

Let’s discuss these medications and how they work…

Methadone is a full mu-opioid receptor agonist with a long half-life (ACOG, 2017; Ecker et al., 2019). Dosage may need to be increased during pregnancy due to increased metabolism and increased clearance of methadone due to physiologic changes of pregnancy (ACOG, 2017; Ecker et al., 2019; SAMSHA, 2018; WHO, 2014). Dosage should be increased if the woman begins to develop symptoms of withdrawal or has increased cravings. Methadone can prolong the QT interval and has significant interactions with many medications. Methadone must be administered under direct observation at a clinic. Barriers to treatment with methadone include transportation or lack of a clinic within location.

Buprenorphine is a partial mu-opioid receptor agonist (ACOG, 2017; Ecker et al., 2019; SAMSHA, 2018; WHO, 2014). Induction of buprenorphine treatment requires that the woman is experiencing withdrawal symptoms otherwise acute withdrawal is precipitated. Withdrawal symptoms usually begin to occur 12-24 hours after short-acting opioids, and 36-48 hours after long-acting opioids. It is available both in office-based settings and through opioid treatment programs. Risks of buprenorphine use include rare incidences of hepatic dysfunction, potential risks during induction due to withdrawal, and does have the potential for diversion.

By far the most important innovation to the treatment of opioid use disorder was the Comprehensive Addiction and Recovery Act (CARA) that was signed into law by President Obama in 2016. While this was more of a public sector innovation, it allowed an increased number of private practices to increase their support for the outpatient treatment of opiate use disorder. CARA made it possible for advanced practice nurses to prescribe buprenorphine in the outpatient setting specifically for the treatment of opioid use disorder. In order to prescribe they must complete 24 hours of specialized training that includes the 8-hour MAT waiver training, that is required by physician prescribers, plus an additional 16 hours (Providers Clinical Support Services, n.d.). Buprenorphine can be prescribed and does not require daily visits for medications which allows for a more private treatment option.

Recommendations from professional organizations like the American College of Obstetricians and Gynecologists (ACOG) and the Society of Maternal Fetal Medicine (SMFM) help to guide the practice of providers in the private sector to provide evidence-based care, and to drive appropriate referrals. While pregnant women with OUD present many challenges to care. Providers must remain current on evidence-based treatment plans and have knowledge of resources in the community that are available to pregnant women. Education should be provided in clear non-judgmental terms regarding their illness, potential outcomes, and potential involvement with child services. Improving care and access to care of pregnant women with OUD will help to improve long term outcomes for these women and their families.

References

American College of Obstetricians & Gynecologists. (2017). ACOG committee opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics & Gynecology, 130, e81-94. doi: 10.1097/AOG.0000000000002235.

Arizona Health Care Cost Containment System. (2020). Effects on opioid receptors. [Picture]. Retrieved from https://www.azahcccs.gov/Members/BehavioralHealthServices/OpioidUseDisorderAndTreatment/MAT.html

Arizona Health Care Cost Containment System. (2020). Opioid receptor. [Picture]. Retrieved from https://www.azahcccs.gov/Members/BehavioralHealthServices/OpioidUseDisorderAndTreatment/MAT.html

Providers Clinical Support System. (n.d.). Waiver Training for Advanced Practice Registered Nurses. Retrieved from https://pcssnow.org/medication-assisted-treatment/waiver-training-for-nurses/

Substance Abuse and Mental Health Services Administration. (2018). HHS Publication No. (SMA) 18-5054: Clinical guidelines for treating pregnant and parenting women with opioid use disorder and their infants. Rockville: Substance Abuse and Mental Health Services Administration.

The Comprehensive Addiction and Recovery Act. (2016, Public Law 114-198). Retrieved from https://www.cadca.org/comprehensive-addiction-and-recovery-act-cara

World Health Organization. (2014). Guidelines for the identification and management of substance use and substance use disorders in pregnancy. Geneva: World Health Organization Press.

Blog Post Week 11:

Discuss the impacts of technology innovations and implications for data and privacy

Initial attempts at dealing with the opioid epidemic were focused on eliminating sources of opioids (Soliz, 2019). Increasing knowledge of addiction as a chronic and complex disease process has increased efforts to support treatment and recovery programs. While there is increased funding available for these programs, there are issues of privacy that must be considered. Women who decide to begin recovery must receive a clear explanation of who will have access to their medical information, and who they want this information shared with. For example, substance use providers and prenatal care providers.

One way that technology benefits women with opioid addiction, is through media attention to the issue. Experts can bring attention to areas that are impacted and reveal data regarding health disparities without revealing individual patient information. Acknowledging the human side of addiction and efforts to improve maternal and family outcomes can help to increase public support of treatment and recovery programs and help to decrease stigma. I had the opportunity to interview Tara Sundem, NNP, a co-founder of the Hushabye Nursery. Hushabye Nursery will be opening in 2020 and is geared to provide recovery centered education and support to pregnant and postpartum women with OUD. She speaks publicly to both health care professionals and the public to promote improvements in family centered recovery options for women with OUD. The goal is to improve long-term outcomes for mothers with OUD and their families. Improved knowledge will help to promote improvements in policies that impact care.

42 U.S.C. 290dd-2 and 42 C.F.R Part 2, which is referred to as Part 2, in general deal with patient privacy of health care data as it applies to treatment for addicition (Soliz, 2019). Part 2 was implemented in the 1970s and was put in place so that addiction treatment could be obtained without stigma. Unfortunately, in today’s healthcare environment, the privacies protected by Part 2 can make it difficult for information to be shared with providers regarding treatments for addiction given the strict rules for patient consent for release of information. During the time of this writing, the Substance Abuse and Mental Health Services Administration (SAMSHA) acknowledges the need for telehealth treatment of substance use disorders due to closures of in person facilities. The medical emergency exception allows for sharing of patient information regarding their treatment without specific written consent to ensure continuity of care (SAMSHA, 2020). Following a disclosure, information regarding the release will be documented in the patient chart.

Arizona Revised Statute (A.R.S.) 36-2606 required the Prescription Monitoring Program. This program allows providers who prescribe opioids and benzodiazepines to review the preceding twelve months of a patient’s history of prescriptions to help to decrease chances of multiple prescriptions from multiple providers (https://pharmacypmp.az.gov/). At the time of this writing this requirement has been temporarily suspended due to the COVID-19 pandemic. Which takes us to another interesting technological innovation…..telehealth.

Telehealth allows providers and patients to connect without having an in-person appointment. During the COVID-19 pandemic, SAMSHA is recommending that states offer take home treatment for both buprenorphine and methadone to decrease in person visits (SAMSHA, 2020). This gives providers at clinics the ability to allow for take home treatment on a case by case basis while continuing to provide support for recovery (Holmes, 2020). In April 2019, Yale received a grant for treatment of OUD in pregnancy via telehealth (Wicklund, 2019). Telehealth could provide an innovative way to increase access to treatment for OUD during pregnancy for women in rural areas who had previously limited access to treatments. Technological advances can provide improvements in care and access to care that can bridge the gap of health disparities.

References

Arizona State Board of Pharmacy. (2020). Prescription monitoring program. Retrieved from https://pharmacypmp.az.gov/

Holmes, C. (2020). Opioid treatment clinics shift to telehealth during coronavirus crisis. ABC15Arizona. Retrieved from https://www.abc15.com/news/local-news/investigations/opioid-treatment-clinics-shift-to-telehealth-during-coronavirus-crisis

Soliz, M. A. (2019). Don’t let privacy protections be the enemy of good: How privacy laws Are stymieing efforts to most effectively treat substance use disorders and combat the opioid epidemic. Journal of Healthcare Compliance. 13-54.Retrieved from https://asu.instructure.com/courses/37263/files/13914945?module_item_id=3013425

Substance Abuse and Mental Health Services. (2020). COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance. Retrieved from https://www.samhsa.gov/sites/default/files/covid-19-42-cfr-part-2-guidance-03192020.pdf

Wicklund, E. (2019). Yale doctors to test telehealth to treat pregnant women with OUD. Yale University researchers will use a $5.5 million PCORI grant to study whether a telehealth platform can help rural health providers improve care for pregnant women struggling with substance abuse. mHealth Intelligence. Retrieved from https://mhealthintelligence.com/news/yale-doctors-to-test-telehealth-to-treat-pregnant-women-with-oud

Week 13: Implications of Healthcare Strategies for Sustaining Innovation

As we have discussed in the previous weeks, opioid use disorder is a chronic and complex condition. It is important to include screening for opioid use, misuse and addiction during prenatal visits to ensure early identification and treatment when needed. Prior to screening, ask permission and respect the answer that is given. During the prenatal period, women have the most interaction with healthcare providers. If permission for screening is not given on the first visit, ask at subsequent visits. Respecting the patient’s answer will help to build a trusting provider/patient relationship. It is important to create a welcoming safe space for prenatal visits that is supportive. Continuity of care should continue into the postpartum period (ACOG, 2017; Ecker et al., 2019).

OUD that is treated has the best outcomes for mothers and babies. The biggest risk for adverse outcomes is when OUD is untreated. Being aware of obstacles to treatment is important to allow for early interventions. The biggest obstacle is often lack of access to care. This can be related to difficulties with transportation or lack of providers, especially in rural areas. Access to care could be improved for a number of women and their infants with the addition of additional facilities that provide care for pregnant and postpartum women with OUD. Improving provider education regarding OUD in pregnancy is imperative to continue to strive for improved outcomes (ACOG, 2017; Ecker et al., 2019).

Additionally, we know that the women in MAR are at the highest risk of relapse, overdose, and death during the postpartum period. Support of policies that continue insurance coverage for women during the postpartum period, up to the first year postpartum can help with continued support and continuity of care that may otherwise be lost when insurance benefits are terminated. Currently SB 1392 would provide extended benefit if passed (ACOG, 2017; Ecker et al., 2019; S.B. 1392, 2020).

In conclusion, it is important to have standardized care for OUD in pregnancy and postpartum. Increasing both provider and community awareness of this chronic health condition can help to decrease stigma and increase opportunity for safe treatment options. Increasing the number of locations that are focused specifically on treating pregnant and postpartum women in recovery from OUD will provide the opportunity for more women and their babies to have increased access to specialized care and lead to improved long-term outcomes.

Thank you for reading my blog.

References

American College of Obstetricians & Gynecologists. (2017). ACOG committee opinion No. 711: Opioid use and opioid use disorder in pregnancy. Obstetrics & Gynecology, 130, e81-94.

S.B. 1392, 2020 fifty-fourth legislature, 2^nd Reg. Ses. (Ariz. 2020).