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Quantum Units Education

The Treatment of Pregnant Women with Opioid Use Disorders

Introduction

1. The term “opioids” refers only to natural opium derivatives.

A. True

B. False


2. Approximately three-quarters of persons with non-medical use of prescription drugs initiate heroin use.

A. True

B. False


3. Most newborns of mothers who used opioids during pregnancy develop symptoms of neonatal abstinence syndrome, a postnatal drug withdrawal syndrome, primarily caused by maternal opioid use.

A. True

B. False


4. The use of medication-assisted treatment during pregnancy is a recommended best practice for the care of pregnant women with opioid use disorders.

A. True

B. False


5. Medication-assisted treatment is the use of:

A. Medications

B. Counseling

C. Behavioral therapies

D. All of the above


Background

6. Compared with continued opioid use, methadone maintenance therapy does all of the following, except:

A. Lower’s the fetus’ risk of becoming dependent on the medication during gestation or experiencing withdrawal when it separates from the placental circulation at birth.

B. Lowers the mother’s risk of developing infectious diseases, including hepatitis and HIV.

C. Lowers the mother’s risk of experiencing pregnancy complications, including spontaneous abortion and miscarriages.

D. Lower’s the mother’s risk of having a child with challenges including low birth weight and neurobehavioral problems.


7. Infants exposed to buprenorphine require longer treatment duration and more medication to treat the symptoms of NAS when compared to infants exposed to methadone.

A. True

B. False


8. Prescribing methadone or buprenorphine during pregnancy is considered “off-label.”

A. True

B. False


9. Induction of naltrexone requires detoxification and an opioid-free period, which may lead to:

A. Relapse vulnerability

B. Re-establishment of physical dependence

C. Possible opioid overdose and death

D. Any of the above


10. Which of the following can affect an infant’s withdrawal symptoms?

A. Exposure to multiple substances.

B. The type of opioid that the mother used.

C. Whether the mother’s opioid use disorder was medically managed.

D. All of the above.


Scope of the Problem

11. In an effort to counter misinformation about pregnant women and prescription opioid use, experts note all of the following, except:

A. Portraying NAS babies as “victims” results in the vilification of their mothers, who are then viewed as perpetrators, and further perpetrates the criminalization of addiction.

B. Newborn babies with NAS are born “addicted.”

C. NAS is treatable and has not been associated with long-term adverse consequences.

D. Using pejorative labels such as “oxy babies,” “oxy tots,” “victims,” “tiny addict,” or “born addicted” places these children at substantial risk of stigma and discrimination and can lead to inappropriate child welfare interventions.


12. The Medicaid patient population is more likely to receive prescriptions for opioid pain medications and to have opioids prescribed at higher doses and for longer periods of time than the non-Medicaid patient population.

A. True

B. False


13. Non-pharmacological treatment is the standard of care for the infant with NAS and should start at birth and continue throughout the infant’s hospitalization and beyond.

A. True

B. False


Guidelines for Supporting Collaborative Policy and Practice

14. Which of the following often results in relapse to former use?

A. Medically supervised tapered doses of opioids during pregnancy.

B. Abrupt discontinuation of opioids in an opioid-dependent pregnant woman.

C. Both (A) and (B).

D. None of the above.


15. Pregnancy in women with opioid use disorder should be co-managed by an obstetrician and an addiction specialist physician.

A. True

B. False


16. Pregnant women who are physically dependent on opioids should receive treatment using:

A. Withdrawal management

B. Agonist medications

C. Abstinence

D. All of the above are equally beneficial to the mother and fetus


17. Mothers receiving methadone and buprenorphine monoproduct for the treatment of opioid use disorders should be discouraged from breastfeeding.

A. True

B. False


18. Every professional involved needs to understand the different contexts of opioid use by a pregnant woman to accurately assess her distinct needs and those of her family members in order to implement the most appropriate and comprehensive plan of care.

A. True

B. False


19. When making decisions about whether to intervene and how to do so in the most supportive manner, staff must take into account the distinctions related to a woman’s:

A. History

B. Motivation

C. Pattern of opioid and other drug use

D. All of the above


20. The Child Abuse and Prevention Treatment Act requires all of the following, except for:

A. States to have policies and procedures for hospitals to notify child protective services of all children born who are affected by illegal substance use or withdrawal symptoms resulting from prenatal drug exposure or indications of FASD.

B. CPS agencies to develop a plan of safe care for every such infant referred to their agency and address the health and substance use disorder treatment needs of the infant.

C. All children who are younger than five years who are substantiated victims of child maltreatment are referred to early intervention agencies that provide developmental disabilities services.

D. CAPTA requires all of the above.


Comprehensive Framework for Intervention

21. Which of the five major time frames when intervention in the life of an infant can help reduce the potential harm of prenatal substance exposure includes promoting awareness among women of child-bearing age and their family members of the effects that prenatal substance use can have on infants?

A. Pre-pregnancy

B. Prenatal

C. Birth

D. Neonatal


A Guide for Collaborative Planning

22. Cross-system initiatives lead to better results by:

A. Facilitating better communication.

B. Clearly defining the roles of the various professionals who serve these families.

C. Maximizing the resources of multiple stakeholders who have a vested interest in accomplishing shared goals.

D. All of the above.


23. Core team members on the collaborative team should, at a minimum, include all of the following, except for:

A. Child welfare professionals

B. Mental health providers

C. Medicare officials

D. Healthcare providers


24. It is critical to ensure that pregnant women or mothers representing the target population have a voice in the process and are active participants in planning, informing, communicating, and collaborating.

A. True

B. False


Concluding Thoughts

25. The prevalence of substance use during pregnancy is often underreported, mostly because:

A. Healthcare providers do not screen pregnant women for substance use.

B. Pregnant women feel shame and guilt.

C. Pregnant women who use substances do not visit healthcare providers.

D. Healthcare providers report the substance abuse to child protective services but then do not follow-up.


26. Most health care systems use universal screening for substance use during pregnancy and delivery.

A. True

B. False


Appendix 1: Facilitator’s Guide

27. Facilitating the System-Specific Guides as a stand-alone tool may be most appropriate for systems that are seeking to:

A. Understand the strengths and opportunities for improvement in policies and practices across systems.

B. Form the basis for action plans specific to each system that can inform the larger systemic action plan.

C. Improve policy and practice in working with parenting and pregnant women with opioid use disorders but have not yet formulated a team approach.

D. Help narrow the scope of the area that the team wants to prioritize.


28. Having an understanding of both the level of agreement and the priority associated with each practice or policy area will facilitate the development of an action plan.

A. True

B. False


29. Using case studies, system walk-throughs, and resource mapping helps to further illuminate:

A. What needs to be addressed and improved.

B. Gaps and barriers in existing programs, services, and resources.

C. Resources and action steps needed to close the gaps and eliminate the identified barriers.

D. All of the above.


30. The purpose of a walk-through is to:

A. Identify points in the process in which a pregnant woman may encounter roadblocks.

B. Help align resources and policies to the goals identified in the action plan.

C. Come to a general understanding of the underlying policies and practices across disciplines that shape the larger systemic response to pregnant women with opioid use disorders.

D. Understand the policies and practices within each discipline’s sphere of practice.


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