Perinatal SUD Care Dyad Package

Five Pillars of Evidence-Based Care

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

Learning Objectives

  1. Define the minimum effective dyad-care package
  2. Compare integrated care models
  3. Understand the "kitchen sink" fallacy
  4. Apply psychiatry curriculum competencies

Slide-by-Slide Notes

Slide 1: Title 2 min
Key Points: Frame the dyad as the unit of care—not mother and infant separately. This is foundational to all five pillars.
Slide 3: The Five Pillars 8 min
Key Points: Walk through each pillar briefly. These are the minimum effective standards—not "nice to haves."
Anticipated Q: "What if we can't implement all five pillars?"
A: Start with Pillar II (rapid MOUD access) and build incrementally. Any step toward integration helps.
Slide 5: Pillar II - Rapid-Access MOUD 6 min
Key Points: Emphasize the 59-90% relapse rate with withdrawal/detox. This is NOT a treatment option in pregnancy. Split dosing in 3rd trimester is critical due to increased metabolism.
Slide 7: Care Models 6 min
Key Points: The "kitchen sink" fallacy: Mandating participation in all services (parenting classes, therapy, groups) as prerequisite for MOUD creates barriers. Low-barrier access with voluntary additional services works better.

Anticipated Q&A

Q: What if a patient wants to breastfeed but is on methadone?

A: Breastfeeding is encouraged if stable on MOUD, HIV-negative, and not using other substances. Transfer to breastmilk is minimal and breastfeeding may reduce NAS severity. Support this choice.

Q: How do we implement Pillar IV (POSC) if CPS is not collaborative?

A: Focus on what you can control: create a robust medical plan that demonstrates engagement and stability. Document all care participation. Use this as evidence regardless of CPS involvement.

Q: Which screening tool should we use?

A: 4P's Plus or 5P's are widely validated. The key is universal application—not selective screening. Pick one tool and use it consistently across your practice.

Key Messages

  1. The mother-infant dyad is the unit of care—separate treatment misses attachment benefits.
  2. Five pillars: Universal screening, rapid MOUD, psychiatric integration, POSC, postpartum transition.
  3. Integrated OB-SUD clinics are the scalable gold standard.
  4. Avoid the "kitchen sink" approach—low-barrier MOUD with voluntary services maximizes retention.