The American College of Obstetricians and Gynecologists issued two new committee opinions — one on managing opioid use disorder in pregnancy, and the other on counseling adolescents about contraception.
In the first, ACOG emphasizes that all pregnant women should be screened for substance use at the first prenatal visit (several screening tools are provided in Box 2 in the paper linked below). For women with an opioid use disorder, opioid agonist pharmacotherapy (methadone, buprenorphine) is still preferred to medically supervised withdrawal because of high relapse rates with the latter. However, if a woman declines agonist pharmacotherapy, medically supervised withdrawal may be considered if done under the care of a perinatal addiction specialist.
Second, in the paper on contraception counseling, ACOG stresses that obstetrician-gynecologists should discuss contraception with teens at every visit regardless of their sexual history. First discussions should occur between ages 13 and 15, and information on the most effective contraceptive methods — e.g., intrauterine devices or the implant — should be prioritized. Additionally, conversations should routinely include emergency contraception.