Mindful Continuing Education

1. Neonatal abstinence syndrome (NAS), a group of physiologic and neurobehavioral signs of withdrawal that may occur in a newborn who was exposed to psychotropic substances in utero, develops among 50 to 80 percent of opioid-exposed infants.

2. According to the authors, barriers to treatment for pregnant and parenting women with opioid use disorder (OUD) include each of the following EXCEPT:

3. Withdrawal symptoms that occur after stopping or reducing opioid use include negative mood, nausea or vomiting, diarrhea, fever, and:

4. When interviewing a pregnant woman with OUD who is presenting for care, a detailed history should be obtained, including illicit and licit substance use before and during pregnancy, current exposure to interpersonal violence, and behavioral health history such as anxiety, depression, or trauma.

5. Since it is widely believed that people with OUD cannot successfully stop smoking or using other substances while they discontinue opioid use, addressing all the used addictive substances at once is not recommended.

6. Women with OUD are at higher risk for HIV/AIDS and viral hepatitis infection than women who do not use substances, so screening for HIV/AIDS and hepatitis B and C should be standard at any initial assessment, regardless of the stage of pregnancy.

7. Although experts don’t agree on whether intrauterine exposure to buprenorphine, buprenorphine/naloxone, or methadone results in lasting developmental or other problems for the infant, a woman receiving either buprenorphine or methadone should be informed that:

8. Treatment plans for pregnant woman with OUD should be:

9. Patients who are new to treatment and resistant to methadone use should be given naltrexone, as it is easy to transfer from naltrexone to methadone later if necessary.

10. Which of the following in NOT a correct statement about managing opioid cravings or withdrawal among pregnant women?

11. Pregnant women with OUD, with or without a history of pharmacotherapy for OUD, should be advised that medically supervised withdrawal from opioids is associated with high rates of return to substance use and is not the recommended course of treatment.

12. Since neonatal abstinence syndrome (NAS) expression and severity are correlated with maternal pharmacotherapy doses, women may be advised to change or reduce their medication in hopes of reducing the risk or severity of NAS in their infants.

13. A pregnant woman will likely need periodic adjustments to the dose of her pharmacotherapy in response to the physiological changes of pregnancy and:

14. A pregnant woman using pharmacotherapy for OUD should also have access to and be encouraged to talk with a behavioral health professional, as counseling can:

15. Recovery, which requires more than pharmacotherapy, is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.

16. While expectant mothers receiving treatment with buprenorphine or methadone who use benzodiazepines should reduce their use if possible, they should not work toward the goal of being benzodiazepine free until after delivery because of the risk of heightened anxiety.

17. Discrimination and bias against people who live with serious mental illness or OUD are widespread, and this may compound the reluctance and fear that pregnant women with OUD or severe mental illness often experience when deciding whether to seek help for these disorders.

18. Returning to substance use is a common occurrence with OUD, especially early in treatment when the medication dose is still being stabilized, and it should be viewed as:

19. Return to substance use is often the result of an interaction of physiological and environmental factors, and is best seen as a dynamic process in which external and internal factors impact the patient’s:

20. Evidence-based treatments can be offered to pregnant women with substance use disorder, and motivational interviewing and contingency management, with a focus on the mother-infant dyad and integration with child protective services and the court, have been recently added to the list of possible approaches.

21. While new research is expected on both maternal cannabis smoking and ingestion of tetrahydrocannabinol, existing evidence shows that maternal cannabis smoking:

22. Infant withdrawal from opioids usually begins a few days after the baby is born but may begin as late as 4 to 6 weeks after birth.

23. Infant-related variables that can affect the infant’s NAS course include genetics, gestational age, and:

24. When appropriate, any amount of breastfeeding, however brief, can decrease NAS severity, reduce the infant’s need for pharmacological treatment, and decrease the length of pharmacological therapy and hospitalization.

25. Each of the following is an accurate statement about pain relief during her labor, delivery, and postpartum period for women with opioid use disorder EXCEPT:

26. The best approach for creating a long-term plan for the infant’s safety and the recovery of a mother with OUD is to focus on maternal drug screens and drug exposure at the time of delivery.

27. Beginning at birth, all infants with NAS should receive nonpharmacologic care, and the substance-exposed mother–infant dyad should consist of:

28. Although a stable mother being treated for OUD with pharmacotherapy is encouraged to breastfeed her infant, careful consideration is needed for women who present to prenatal care and/or SUD treatment during or after the second trimester, women who return to illicit substance use/licit substance misuse, and women who attained abstinence only in an inpatient setting.

29. The discharge plan for infants treated for NAS should include home visitation and early intervention services, such as including a home nursing consult, a social work consult, referrals to healthcare professionals who are knowledgeable about NAS and accessible, and parenting support that is:

30. A small study following prenatally opioid-exposed children for 5 years concluded that a parent– healthcare professional relationship established in pregnancy and continued during the postpartum period facilitated a long-lasting relationship with childhood professionals and reduced court-ordered placements and reports of developmental disorders.

31. After controlling for confounding factors, such as maternal psychological distress and instability in the home environment, infants born to mothers who received methadone or buprenorphine during pregnancy were found as toddlers to have slightly more significant problems with developmental tasks than children of mothers without SUD.

32. In the immediate postpartum period, evaluation of the new mother’s dose of agonist therapy should be prompted if there are complaints of drowsiness and:

33. When a new mother who is stable on methadone or buprenorphine requests a switch to naltrexone, she should be made aware that the risk of return to substance use is high in this case, and that a change should not be made without a compelling reason.

34. In order to help those seeking recovery from SUDs avoid triggers that can lead to return to substance use, Substance Abuse and Mental Health Services Administration encourages the use of peer counselors or:

35. A comprehensive wellness model is recommended to enable healthcare professionals to work across disciplines and specialties and to provide services as needed to reduce maternal stress and risk of return to substance use.

36. Privacy requirements are higher with issues of SUD than with other conditions, so it is especially important to obtain signed informed consent agreements tailored to SUD issues to facilitate sharing of information among healthcare professionals.

37. One essential strategy that is critical to success in caring for parenting women with OUD is offering non-coercive contraceptive counseling and the option to leave the hospital with a prescription for contraception, contraceptive supplies, or a contraception plan.

38. Which of the following is NOT one of the advanced steps recommended by the authors when implementing treatment for pregnant and parenting women with OUD in a clinical setting?

39. In order to build community partnerships for treating pregnant and parenting women with OUD, relationships with an experienced referral center can be developed and regular calls with other care providers in the community to informally discuss cases and share expertise can be initiated.

40. Peer support specialists are individuals in recovery who have skills with mental illness, trauma, and/or substance use disorder that they learned in formal training, and they are distinguished from members of mutual-help groups because they are paid professionals rather than volunteers.