ACOG Practice Patterns related to Opioid Use during Preg

Draft Form Approved

OMB No. 0920-xxxx

Exp. Date xx/xx/xxxx

If you do not treat pregnant women please check this box □ and return the survey blank.

Practice Patterns related to Opioid Use during Pregnancy and Lactation

Prenatal & Postpartum Care

1. To what extent is any routine screening of the following among pregnant patients in your practice a priority?

	Not a priority	Moderate priority	High priority
a. Prescription opioid use			
b. Non-medical use of prescription opioids (i.e. using opioids for reasons other than prescribed)			
c. Non-medical use of other prescription medications (benzodiazepines, barbiturates, etc.)			
d. Illicit substance use (heroin, cocaine, hallucinogens, etc.)			
e. Marijuana use			
f. Tobacco use			
g. Alcohol use			
h. Depression			

2. How does your practice obtain information about pregnant patients’ substance use (including illicit use and non-medical use of prescription opioids)? ( all that apply)

 A physician asks the patient  Other staff asks the patient

 Patient fills out a questionnaire  Biologic test

 Other: _____________________________________

 I do not screen my pregnant patients for substance use → SKIP to question 5

3. In your practice, how often do you screen for substance use among pregnant patients

 Never  Rarely  Sometimes  Usually  Always

 My practice does not screen for substance use

4. If your practice uses a questionnaire to assess substance use, please check the one most frequently used:

 My practice does not use a standard screener

 4P’s Plus© Screen for Substance Use in Pregnancy

 5Ps Prenatal Substance Abuse Screen

 Substance Use Risk Profile –Pregnancy (SURP-P)

 CRAFFT screener for Adolescent and young adult substance abuse

 Wayne Indirect Drug Use Screener (WIDUS)

 National Institute on Drug Abuse (NIDA) Quickscreen

 Other (please specify):____________________________________

The following questions are on your practices, beliefs and attitudes on opioid use disorders.

5. Do you typically refer patients who have opioid use disorder in pregnancy to other prenatal care providers or manage their care yourself?

 Refer to another provider  Manage the patient myself

 Co-manage the patient with another provider

6. To whom do you typically refer pregnant patients who have opioid use disorders?

	Never	Rarely	Sometimes	Usually	Always	N/A
a. Maternal fetal medicine						
b. Addiction specialist						
c. Psychiatry						
d. Family therapist						
e. A treatment program or facility within my institution						
f. A treatment program or facility outside of my institution						
g. A nutritional education program						
h. Other (please specify): ______________						

7. For patients you refer to opioid-assisted therapy (OAT), also referred to as medication assisted recovery or medication-assisted therapy (MAT), do you communicate with an addiction specialist/ treatment facility staff regarding the patients’ status?

 Never

 Rarely

 Sometimes

 Usually

Always

 N/A

8. How do you manage pregnant patients who have opioid use disorders (illicit use or non-medical use of prescription opioids)?

	Never	Rarely	Sometimes	Usually	Always
a. Advise opioid cessation					
b. Advise inpatient, monitored withdrawal					
c. Advise methadone maintenance					
d. Advise buprenorphine maintenance (i.e. subutex)					
e. Advise buprenorphine and naxolone maintenance (i.e. suboxone)					
f. Conduct brief intervention/motivational interviewing/cognitive behavioral therapy					
g. Screen for alcohol or tobacco use					
h. Screen for depression					
i. Screen for anxiety or use of benzodiazepines					
j. Screen for intimate partner violence					
k. Inform about fetal effects (e.g., Neonatal Abstinence Syndrome)					
l. Do nothing					
m. Other (please specify):___________________					

9. Do you communicate any information about your patients with opioid use disorders during pregnancy to:

	Never	Rarely	Sometimes	Usually	Always
a. Hospital pediatric team prior to delivery					
b. The newborn’s pediatrician after delivery					
c. Lactation Consultant					
d. Social work					
e. Child Protective Services					
f. The police					

10. Is reporting of opioid use disorders during pregnancy or at delivery mandatory in your State?

 Yes  No  I do not know

11. How do you manage postpartum patients who have opioid use disorders (illicit use or non-medical use of prescription opioids)?

	Never	Rarely	Sometimes	Usually	Always
a. Advise opioid cessation					
b. Advise inpatient, monitored withdrawal					
c. Advise methadone maintenance					
d. Advise buprenorphine maintenance (i.e. subutex)					
e. Advise buprenorphine and naxolone maintenance (i.e. suboxone)					
f. Recommend breastfeeding if on opioid-assisted therapy					
g. Counsel on effective contraceptive methods (long acting reversible contraceptives, oral contraceptives, etc.)					
h. Refer to a treatment program or facility					
i. Refer to addiction specialist					
j. Refer to psychiatry					
k. Screen for alcohol and tobacco use					
l. Screen for depression					
m. Screen for anxiety or use of benzodiazepines					
n. Screen for intimate partner violence					
o. Do nothing					
p. Other (please specify):________					

12. To what extent is prescribing effective contraceptive methods (e.g. long acting reversible

contraceptives, oral contraceptives, etc.) for patients who have opioid use disorder during pregnancy before hospital discharge a priority for you?

 Not a priority  Moderate Priority  High Priority  I do not prescribe contraceptives before hospital discharge

Provider Beliefs and Attitudes

13. Approximate to the best of your ability the percentage of your pregnant patients who have opioid use disorders? _______%

14. To what extent do you agree or disagree with the following statements?

	Disagree	Neutral	Agree
a. Patients with opioid use disorders should completely quit during pregnancy.			
b. Patients with opioid use disorders to cut down on the amount used per day during pregnancy.			
c. Women on opioid-assisted therapy should be encouraged to breastfeed.			

15. Do you feel confident that you can appropriately treat your pregnant patients who are using the following substances?

	Not Confident	Somewhat Confident	Confident	Very Confident
a. Opioids				
b. Marijuana				
c. Tobacco				
d. Alcohol				

16. To what extent are the following potential barriers to screening and treating pregnant and postpartum patients for opioid use disorder?

	Not a Barrier	Minor Barrier	Major Barrier
a. Time limitations during patient visits			
b. Concern about patient confidentiality issues			
c. Patient sensitivity to this topic (e.g., fear of offending patients)			
d. Patient denial or resistance			
e. Doubt about the efficacy of brief intervention			
f. Limited training or experience in screening for opioids			
g. Limited training or experience in treating opioid use disorder			
h. Lack of facilities/resources for treatment of opioid use disorder once identified			
i. Lack of or inadequate financial reimbursement for opioid screening, assessment, and counseling			
j. Patient inability to pay for treatment			
k. State reporting laws and repercussions for patients			
l. Not sure what screener to use			
m. Other (please specify):____________________________________			

17. Please indicate how much you agree or disagree with each statement:

	Strongly Disagree	Disagree	Neutral	Agree	Strongly Agree
a. It is my responsibility to screen all pregnant patients for substance use.					
b. It is my responsibility to be aware of local resources available for patients with substance use disorders.					
c. It is my responsibility to make sure patients enter treatment after I refer them.					
d. When there is a legal or medical obligation for testing patients for substance use, it is my responsibility to notify patients of this testing.					

18. Does the Affordable Care Act include a provision that requires that pregnant patients on Medicaid receive coverage for comprehensive substance use services, including both counseling and pharmacotherapy?  Yes  No  Don’t Know

19. In general, how prepared do you feel to do the following in your clinical practice:

	Very Unprepared	Somewhat Unprepared	Somewhat Prepared	Very Prepared
a. Screen pregnant patients for opioid use disorder				
b. Conduct brief interventions with pregnant patients who use opioids				
c. Educate pregnant patients about the effects of opioids on their fetus/baby				
d. Utilize resources to refer patients who need a opioids cessation program				
e. Prescribe opioid-assisted therapy for pregnant patients				
f. Screen postpartum patients for opioid use disorder				
g. Educate breastfeeding patients about the effects of opioids on their infant				
h. Prescribe opioid-assisted therapy for non-pregnant patients				

20. In which cases do you prescribe naloxone? ( all that apply)

 To all pregnant patients who are prescribed long-term opioids

 To all pregnant patients who have opioid use disorder

 To all pregnant patients who are at risk of experiencing or witnessing an overdose

 I never prescribe naloxone to pregnant patients

I don't know what naloxone is

21. What resources do you need to improve treatment of opioid use disorder in your clinical practice? ( all that apply)

	Patient information regarding adverse reproductive outcomes associated with opioids
	Patient information regarding infectious disease associated with use by injection
	Referral resources and treatment facilities for pregnant and postpartum patients with opioid use disorder
	Access to phone consultation line to ask questions regarding opioid use disorders in pregnant patients
	Information regarding relapse prevention for patients who seek treatment for addiction in pregnancy
	Specific standardized screening questionnaire for substance use during pregnancy
	Training and advice on brief interventions/motivational interviewing
	Reimbursement by insurance for screening and assessment
	Other, please specify: _____________________________________________

Demographics

22. Gender:  Female  Male 23. Years of practice post-residency: ______

24. What racial/ethnic group do you most identify with? ( all that apply)

 American Indian or Alaska Native  Asian  Black or African American

 Hispanic or Latino  Native Hawaiian/ Other Pacific Islander White

25. Are you certified as an addiction specialist?  Yes  No

26. Are you board certified in MFM?  Yes  No

27. In what state is your practice located? ______

28. Which best describes your current practice? (select one)

 Solo private practice  Ob/Gyn partnership/group  Multi-specialty group

 Hospital or clinic  University full-time faculty & practice

 HMO/Staff model  Other (please specify): ______________________________

29. Which of the following best describes your practice location? (select one)

 Urban – inner city  Urban – non-inner city  Suburban

 Mid-sized town (10,000-50,000)  Rural  Military

30. What is the approximate racial/ethnic distribution of your active patient population (Give a percentage for each; total must equal 100%)

American Indian or Alaska Native: _________% Asian: _________%

Black or African American: _________% Hispanic or Latino: _________%

Native Hawaiian or Other Pacific Islander: _________% White: _________%

31. Please estimate the percentage of your patients who are:

Medicaid insured: ________% Privately insured: ________% Uninsured: ________%

32. Approximately how many new pregnant patients do you see in a month? ____________

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