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The Indian Health Service is working with the American College of Obstetricians and Gynecologists to create an opioid-use treatment program tailored for American Indian and Alaskan Native women who are pregnant or of reproductive age.

“American Indian or Alaska Native women have the highest risk of dying from a prescription opioid overdose,” according to the Centers for Disease Control and Prevention. “Native women with opioid use disorder encounter specific barriers to access for services for treatment of mental health disorders, personal histories of trauma and accompanying opioid use disorder, and outcomes related to neonatal opioid withdrawal.”

Opioid use disorder is defined as “a pattern of opioid use characterized by craving, inability to control use, and continued use despite knowledge of adverse consequences to self, relationships, health, and livelihood.” It can have negative impacts on mothers, babies, families, relationships, and communities.

These new recommendations fall under the four areas of prevention and screening, medication-assisted treatment, integration of prenatal care, and consideration of delivery and postpartum care of women with opioid use disorder.

“The real difference and the groundbreaking part of this is these recommendations are tailored for Native communities,” said Rear Admiral Michael Toedt, chief medical officer of Indian Health Service in a media phone conference.

The guidelines were developed by the college and IHS, experts on the subject matter, healthcare providers, tribal programs, organizations, after input from Native communities.

Dr. Barbara S. Levy, vice president of health policy at the American College of Obstetricians and Gynecologists said professional organization came together in the last couple years to make these changes happen in Native communities, which includes urban areas and tribal lands.

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The American College made site visits to Native communities and found that many of these recommendations can be adapted for Native women who are pregnant or of childbearing age, especially those who live in rural areas. Those adaptations are unclear due to limited data.

She said when culture and tradition are integrated with the medical care for women with opioid use disorder, there is more community engagement resulting in better outcomes for the women, babies, and families.

Dr. Levy also mentioned that these recommendations also include “trauma-informed approaches” because pregnancy may be triggering to women who have experienced violence.

“Most women with substance misuse also have a history of trauma. Therefore, trauma-informed approaches to opioid use disorder in women are essential,” as stated in a press release. “Interdisciplinary approaches to post- traumatic stress disorder that engage tribal resources, social structures, and assets are crucial to impactful care of opioid use disorder.”

From the IHS and American College report, specific guidelines to help Native women who are pregnant or of childbearing age include:

  • Screening for opioid use using screening tools for women of reproductive age
  • Start medication-assisted therapy for pregnant women with opioid use disorder along with counseling and other mental health services
  • Treat mothers and infants as a pair of individuals postpartum to “improve the course of neonatal opioid withdrawal symptom”
  • “Opioid use disorder is a chronic, relapsing and remitting medical illness that can be managed successfully with a combination of behavioral therapy, medication-assisted therapy, and recovery support.” 
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Jourdan Bennett-Begaye, Diné, is a reporter/producer for Indian Country Today in Washington, D.C. Follow her on Twitter: @jourdanbb. Email: