American College of Obstetricians and Gynecologists and American Society of Addiction Medicine Committee Opinion: Opioid Use and Opioid Use Disorder in Pregnancy, (2017).
Quote
“Pregnancy should not be a reason to avoid treating acute pain because of concern for opioid misuse or NAS” (p.4).
“Obstetric care providers have an ethical responsibility to their pregnant and parenting patients with substance use disorder to discourage the separation of parents from their children solely based on substance use disorder, either suspected or confirmed.”
“For pregnant women with an opioid use disorder, opioid agonist pharmacotherapy is the recommended therapy and is preferable to medically supervised withdrawal because withdrawal is associated with high relapse rates, which lead to worse outcomes. More research is needed to assess the safety (particularly regarding maternal relapse), efficacy, and long-term outcomes of medically supervised withdrawal” (p.2).
“Early universal screening, brief intervention (such as engaging the patient in a short conversation, providing feedback and advice), and referral for treatment of pregnant women with opioid use and opioid use disorder improve maternal and infant outcomes” (p.1).
“Neonatal abstinence syndrome is an expected and treatable condition that can follow prenatal exposure to opioid agonists and requires collaboration with the pediatric care team for care of the infant.”
“ A positive drug test result is not in and of itself diagnostic of opioid use disorder or its severity.”
Article primary conclusion
This Committee Opinion (2017, reaffirmed 2021), developed by the American College of Obstetricians and Gynecologists (ACOG) in collaboration with the American Society of Addiction Medicine (ASAM) and endorsed by the Society for Maternal-Fetal Medicine (SMFM), provides evidence-based guidance on opioid use and opioid use disorder (OUD) during pregnancy. The document recommends universal screening for substance use using validated verbal screening tools, emphasizes that opioid agonist treatment with methadone or buprenorphine is the recommended treatment for pregnant people with OUD, and states that treatment is preferable to medically supervised withdrawal because withdrawal is associated with high relapse rates and worse outcomes.
The opinion distinguishes verbal screening from urine drug testing and states that urine testing should be performed only with the patient's consent and in compliance with state law. It notes that a positive drug test is not diagnostic of opioid use disorder, that urine testing has important limitations, including false-positive results, and that patients should be informed of the potential legal consequences of testing.
ACOG further recommends coordinated multidisciplinary care during pregnancy and the postpartum period, encourages breastfeeding for patients who are stable on methadone or buprenorphine, describes neonatal abstinence syndrome as an expected and treatable condition, and states that obstetric providers have an ethical responsibility to discourage separation of parents from their children solely on the basis of substance use disorder. The opinion concludes that a coordinated multidisciplinary approach without criminal sanctions offers the best opportunity to improve outcomes for infants and families.
Article context
This Committee Opinion represents the formal position of ACOG, developed in collaboration with ASAM and endorsed by SMFM, making it one of the most influential Professional Society StatementDefinition: A professional society statement reflects consensus recommendations developed by experts based on research evidence and clinical experience.Evidence quality: These statements sit lower on the evidence pyramid because they rely on expert interpretation rather than new empirical data.Court use: Courts may consider these statements as guidance on professional standards, but they should not be treated as independent scientific proof.Glossary › on opioid use disorder during pregnancy. Although it does not generate new evidence, it synthesizes existing research and translates that evidence into clinical and policy recommendations. The document is notable for distinguishing universal verbal screening from urine drug testing, supporting medications for opioid use disorder during pregnancy, and recognizing the potential harms of criminalization and family separation. Its reaffirmation by ACOG in 2021 suggests that its core recommendations remained consistent with contemporary standards of care several years after publication.
Editor's note
This document helped establish many of the principles that later became common across ACOG, ASAM, SMFM, AAP, and other professional organizations: universal screening, treatment over punishment, MOUD as Standard of CareWhat it is: What a reasonably competent professional would do under similar circumstances.Does not mean legally: Standard of care is not defined by a single study, guideline, or outcome.Glossary ›, NAS as expected and treatable, caution regarding toxicology testing, and opposition to family separation based solely on substance use disorder.