A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

Abstract

Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for co-occurring posttraumatic stress disorder in pregnant women who use substances in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.

Keywords:

• pregnancy
• opioid
• PTSD
• methadone
• buprenorphine
• perinatal
• multidisciplinary

ACKNOWLEDGMENTS

The authors thank Alan Green, MD, Leslie DeMars, MD, Emily Baker, MD, Michelle Russell, MD, MPH, and Miriam Cordell, CNM, MS, for their strong support of a collaborative approach to perinatal addiction treatment.

DISCLOSURES

The authors report no financial relationships with commercial interests.

FUNDING

This work was supported in part by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001086 (pilot funding to SCA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. DJG received fellowship support from the Veteran's Health Administration Quality Scholars Program during the time this manuscript was prepared. The views expressed in this paper do not reflect those of the Veteran's Health Administration or the United States Government.