Milagro and Perinatal Substance Abuse Resources

 Subutex  

• Subutex Start H&P
• Subutex Induction SOP 
• Subutex Induction Case
• MCH Buprenorphine Patient Agreement 
• FDA Buprenorphine Patient Information Handout
• COWS Scale 

Switching to Suboxone postpartum

Please discharge women on Subutex on suboxone postpartum. We are trying to switch everyone at the time of hospital discharge and not in clinic.

Methadone

• UNM MFM Methadone Induction Protocol  - 2011 
• Methadone Induction & Stabilization Guidelines 
• Methadone Induction Protocol 
• Methadone Triage Dosing Guidelines 
• WHO Methadone Guidelines  

Methadone Missed Dose Guidelines

                This is for re-start admissions only.  *** You cannot give missed doses in triage***

• Missed 1-3 days:  no reduction necessary, provide full dose
• Missed 4-6 days:  reduce dose by 30% of full dose for first day, then resume full dose at second day
• Missed 7-14 days:  reduce dose by 50% of full dose on first day, then reduce 30% of full dose on second day, then resume full dose on third day
• Missed >15 days: methadone induction/re-start required

Methadone dosing at ASAP:

ASAP is now closed on Saturday and Sundays as are all Opioid Treatment Programs (“Methadone clinics”). 

If women miss Friday they will not have a Saturday or Sunday take home dose.  However, most women are now receiving a week of take-home doses due to COVID.  A missed dose is not an indication for admit if not in moderate withdrawal as defined by COWS score of 12 or more. 

Women being discharged on postpartum Friday can’t get a Saturday or Sunday dose at ASAP and can’t get a dose in triage. Options are:

1) Discharge on Sunday

2) Discharge early enough on Friday morning (usually by 8 am) to get to ASAP- this should only be done after talking to ASAP on Friday to have plan in place

3) Defer discharge to 8 pm Saturday with patient understanding she will have 36 hours till her Monday dose- some patients will decline this option.

We are in process of revising the Methadone in triage and induction SOP and will send this out when it is completed.

Benzo Taper

• Project Echo Benzo Taper Presentation

Opioid Use Disorder Guidelines

• ASAM National Practice Guideline for use of Medications in the Treatment of Addition Involving Opioid Use 
•  includes section on switching from methadone to bup
• SAMHSA Clinical Guidelines for the Use of Buprenorphine in the Treatment of Addiction 
•  includes section on switching from methadone to bup
• COWS Scale
• Transitioning from Methadone to Buprenorphine in Pregnancy 

Milagro Prenatal Care Guidelines on a Page 

• Prenatal care on a page

• downloadable word document

• Prenatal care on a page

• web based 

• Prenatal visit template  - document

• Prenatal visit template - web based 

Stimulant Use

• Start fetal testing at 32 weeks with NST and AFI once a week
• Recommend delivery at 38 weeks if continued use due to risk of abruption and IUFD (RR=5) 

UNM Guidelines

• UNMH Policy for breastfeeding and substance abuse
• Guidelines for Peripartum Pain Management in Opioid Dependent Women

Patient Handouts

• Hepatitis C and Breastfeeding

• Hepatitis C and Pregnancy 

• Using Marijuana While Pregnant or Breastfeeding
• Using Marijuana While Pregnant or Breastfeeding - Spanish

   

Mariposa

• Mariposa application  
• Have patient complete application.  Then fax to Milagro at 994-7930.  They will then fax to Mariposa.  Mariposa will only accept the application if it is faxed from the Milagro fax machine at ASAP.  

 Breastfeeding Articles

• The Right to Mother's Milk. A Call for Social Justice that Encourages Breastfeeding for Women Receiving MAT for OUD

• Transfer of Methamphetamine into Breast Milk and Urine  

• Breastfeeding Intention Compared with Breastfeeding Postpartum Among Women Receiving MAT

• Breastfeeding Motivators and Barriers in Women Receiving Medications for OUD