Advisor Dr. Linda Graf, DNP, CNM, WHNP-C, APN, RN Best Evidence-Based Practices for Helping Women that are Addicted to Opiates During Pregnancy Jordan Edwards Advisor Dr. Linda Graf, DNP, CNM, WHNP-C, APN, RN Background Methods Results Opiate drug overdoses were the leading cause of accidental death in the United States in 2014. Among the 21.5 million drug-addicted Americans over age 12 in 2014, over 2 million had substance use disorders involving prescription painkillers or heroin. The rate of women abusing opiates (both prescribed and illegal) has doubled since 2010, and a large majority of these women are within 18-25 years of age. With the majority of the women that are abusing opiates being of reproductive age, this makes the exploration of the effects of opiate abuse on fetuses particularly important Research shows that women age 18-25 who abuse opiates are also likely to have a lower socioeconomic status, family instability, do not receive adequate prenatal care, and are more likely to supplement their addiction with other substances that could harm a growing fetus. Opiate abuse is associated with increased likelihood of preterm labor, early onset delivery, poor fetal growth, and stillbirth. These factors point out the importance of approaching maternal opiate addiction with evidence-based practice and non-judgemental education. Research Design An Integrative Literature Review Literature Searching Strategies: Use of CINAHL, PubMed, PsycInfo, ProQuest Nursing & Allied Health Database, Centers for Disease Control and Prevention, and EBSCO Host. For this search, the terms pregnancy, opiate use, effects of opiate use on pregnancy, and several combinations of these terms were explored. Literature Search Limitations/Exclusion Criteria: Figure 1: Literature Search and Results on best practices for helping pregnant women addicted to opiates Recommendations for the Most Appropriate Education Models Recommendations for the most appropriate education models for pregnant women addicted to opiates address the three major factors discussed in Dorothea Orem’s Theory of Self Care with proposed solutions drawing from pieces of each of the evidence-based best practices discussed. Focuses of Education Models The focus of education models should be centered around empowering women with the resources needed to effectively integrate and maintain a self-care regimen that allows them to live drug free. Recommendation for Most Appropriate Education Models Education models for pregnant women addicted to opiates can follow the framework of Orem’s Self-Care Theory with proposed solutions drawing from pieces of each of the evidence-based best practices discussed. Each of the three factors that contribute to one's ability to partake in their self-care including patient agency, society, and agency can be directly related to pregnant women struggling with opiate addiction: Lack ability to reason effectively because of the stronghold addiction has on their judgement More likely to have uncontrollable societal influences that have either led them down road of addiction, or make it harder for them to quit drug use Can have uncontrollable influences that contribute to their addiction such as socioeconomic status, physical dependence on drug itself, traumatic life events, or injury that led them to addiction Recommendation for Treatment Programs Table 2. Proposed solution for each factor influencing self-care Extensive Preventative Education Education to all women of childbearing age Screening young women for signs of addiction Clear communication about resources available to women who need help Drug therapy Education on the importance of medication adherence Clear instructions of how to use methadone or buprenorphine to eventually get to a stage they will no longer need drugs to fight addiction Multi-faceted Approach to Care Option for both inpatient and outpatient treatments Inclusion of psychological support Support groups Long-term follow up plans Purpose Results Among the articles reviewed on this topic, the three best practices for helping women addicted to opiates during pregnancy were identified. Those included: (1) drug therapy treatment (2) the importance of early interventions and education (3) the need for multifaceted approaches to treatment to ensure long-term success for pregnant women addicted to opiates. Table 1. Three Effective Evidence-Based Interventions Examine the most effective education methods in decreasing the use of opiates in women during and after pregnancy. Review best practices to be used by nurses when implementing interventions for opiate-addicted pregnant women Identify effective education methods to promote sustained abstinence or decreased drug use during the perinatal period. Application of Orem’s Self Care Theory Limitations Conclusion As the opiate epidemic continues to have a stronghold on Americans, it is important that research continues to explore the most effective treatment options and education models for women that are addicted to opiates during pregnancy. There are limited studies on effective treatment plans and education models for this population. Current best practices for pregnant women that are addicted to opiates include drug therapy treatment, emphasis on the importance of early interventions and education, and the need for multifaceted approaches to treatment. Recommendations to develop effective education models for this population address the three components of Orem’s Self Care Theory with proposed solutions for each component as it specifically relates to the target population. Limited research on evidence-based best practices for opiate addiction in pregnant women specifically Small number of studies on successful treatment of this population Conceptual Framework