822: Psychosocial background of pregnant women with opiate use disorder (OUD)

Abstract

The current management of chronic pain has fueled the OUD epidemic in the United States. OUD has also increased during pregnancy. To our knowledge, the primary initiating events leading to opiate use in pregnancy has not been examined. The study objective was to evaluate the psychosocial background and initiating events leading to OUD in pregnant patients. We performed a prospective study collecting data on all pregnant women with OUD seen in our designated substance use disorder clinic. Data collection came from intensive interview sessions and included drugs used, the age opiates were started, whether other substances were used prior to beginning opioid use, and the background events that preceded the use of opiates. Simple statistics with Poisson binomial 95% CI’s were performed. From 11/1/2015 through 7/15/2016, 192 pregnant women underwent an intense psychosocial background evaluation that preceded their OUD. The Table shows that the majority (61.5%, 95% CI 54-68%) have a history of abuse that is most often sexual (prior to the age of 13 in half the cases) and/or involves physical abuse as precipitating events leading to the use of illicit substances. The gateway drug to opiates was found to be THC (marijuana) in nearly half the cases (45%, 95% CI 38-52%). Mismanagement of chronic pain occurred in no more than 10% of the cases. The precipitating background history for OUD in pregnancy (in the Appalachia region) is primarily due to a history of abuse (mainly sexual and physical) and not the mismanagement of chronic pain. However, the diversion of prescription opiates has led to an availability of these drugs on the street for women to misuse, once they initiate the use of illicit substances (which often began with THC). Further research needs to occur in other areas of the country to see if our findings are consistent with other pregnant OUD populations. For primary prevention to be successful in our region, the focus needs to involve early identification of young women who have experienced abuse followed by psychotherapy and/or other interventions.