Perinatal OUD Continuity & Retention

Speaker Companion — Pregnancy Through 12 Months Postpartum

⏱️ Duration: 45 minutes | Audience: Psychiatry, OB, Addiction Medicine, Social Work

Learning Objectives

  1. Identify predictors of MOUD initiation and retention through 12 months postpartum
  2. Map handoff failure points across the care continuum
  3. Compare care delivery models for perinatal OUD
  4. Apply ASAM Criteria to level-of-care decisions

Timing Breakdown

SegmentSlidesTime
Introduction & The Crisis1-38 min
Handoff Failure Points4-58 min
Care Models & Policy6-812 min
Equity, Metrics & Conclusion9-1212 min

Slide-by-Slide Notes

Slide 1: Title 2 min
Key Points: Emphasize this is about the entire continuum—pregnancy through 12 months postpartum. The postpartum period is often overlooked.
Slide 2: The Crisis 4 min
Key Points: Highlight the 81% increase and that 60-73% of deaths occur OUTSIDE healthcare settings. This drives home the need for community-level interventions like naloxone distribution.
Anticipated Q: "Why did overdose deaths increase so dramatically?"

A: Fentanyl saturation of the drug supply, combined with loss of tolerance postpartum and treatment gaps.

Slide 3: MOUD Retention Data 4 min
Key Points: The 80% vs 34% comparison is striking. Emphasize that every trimester of MOUD exposure matters. Early engagement is a modifiable predictor.
Slide 4: Handoff Failure Points 6 min>
Key Points: These are concrete places where systems fail. Ask audience: "Which of these failure points is most relevant in your setting?"
Slide 6: Policy Environment 6 min
Anticipated Q: "What about states with punitive policies? What can we do?"

A: Advocate locally. Implement non-punitive practices within your institution. Track outcomes to demonstrate effectiveness.

Anticipated Q&A

Q: How do we actually implement warm handoffs in practice?

A: Warm handoffs require four elements: (1) Schedule the follow-up appointment before discharge, (2) Direct phone call between inpatient and outpatient provider, (3) Provide bridge medication supply, (4) Document in discharge summary.

Q: What about patients who decline MOUD?

A: Use motivational interviewing. Emphasize that MOUD is protective for both mother and baby. Document the offer and patient's rationale for refusal. Revisit at subsequent visits.

Q: How do we address equity disparities in our practice?

A: Start with data—stratify all metrics by race/ethnicity. Use standardized protocols to reduce implicit bias. Ensure diverse representation in patient advisory boards. Address structural barriers (transportation, childcare).

Key Messages

  1. The postpartum period (7-12 months) is the highest-risk window for overdose.
  2. MOUD retention at 12 months: 80% if initiated early in pregnancy vs 34% if initiated in final month.
  3. Handoff failures account for most gaps in care—warm handoffs at every transition are essential.
  4. Policy matters: Medicaid extension and telehealth flexibilities save lives.
  5. Track equity-stratified metrics to identify and address disparities.