Witcraft Sara M, Johnson Claire, Guille Constance
Department of Psychiatry and Behavioral Sciences (all authors) and Department of Obstetrics and Gynecology (Guille), Medical University of South Carolina, Charleston.
Focus (Am Psychiatr Publ). 2024 Jan;22(1):25-34. doi: 10.1176/appi.focus.20230018. Epub 2024 Jan 12.
Drug overdose is a leading cause of maternal mortality. Psychiatrists can play a critical role in reducing these deaths by delivering effective evidence-based treatments for perinatal opioid use disorder (POUD), including the use of buprenorphine. Medications for POUD (i.e., buprenorphine, methadone) are life-saving treatments, but only half of those who are diagnosed as having POUD will receive this treatment, which can result in an increased risk for return to opioid use, overdose, and death. Psychiatrists are well positioned to prescribe buprenorphine given the Drug Enforcement Administration's (DEA) removal of the requirement to submit a Notice of Intent to prescribe buprenorphine for the treatment of opioid use disorders. Psychiatrists who have a current DEA registration that includes Schedule III authority may now prescribe buprenorphine for opioid use disorders; the training requirements to do so are outlined herein. This article reviews the standard of care for screening, diagnosis, and treatment of POUD, and prescribing buprenorphine for POUD, as well as shared decision-making for medication selection, induction, and maintenance of buprenorphine during pregnancy, labor and delivery, and the postpartum year.
药物过量是孕产妇死亡的主要原因。精神科医生可以通过提供基于循证的有效围产期阿片类药物使用障碍（POUD）治疗方法，包括使用丁丙诺啡，在减少这些死亡方面发挥关键作用。用于POUD的药物（即丁丙诺啡、美沙酮）是挽救生命的治疗方法，但只有一半被诊断为患有POUD的人会接受这种治疗，这可能会增加重新使用阿片类药物、药物过量和死亡的风险。鉴于美国缉毒局（DEA）取消了开具丁丙诺啡治疗阿片类药物使用障碍时提交意向通知的要求，精神科医生有很好的条件来开具丁丙诺啡。拥有当前DEA注册且包括III类药物处方权的精神科医生现在可以开具丁丙诺啡用于治疗阿片类药物使用障碍；本文概述了这样做的培训要求。本文回顾了POUD筛查、诊断和治疗的护理标准，以及为POUD开具丁丙诺啡的方法，以及在怀孕、分娩和产后一年内选择、诱导和维持丁丙诺啡用药的共同决策。
