Overdoses are now the leading cause of pregnancy-associated death in Fla. According to the Florida Pregnancy-Associated Mortality Review, more deaths occur related to drugs than due to complications related to pregnancy, accounting for one in four of these deaths.

To combat this crisis, the USF College of Public Health’s Chiles Center faculty and students in partnership with the Florida Perinatal Quality Collaborative (FPQC) started the Maternal Opioid Recovery Effort (MORE) initiative to promote strategies that improve health care quality for these vulnerable women. Since 2020, they have worked with 33 hospitals across the state, Medicaid and other state partners to prevent these deaths.

The initiative, which runs through June 2022, goal is to work with providers, hospitals and other stakeholders to improve identification, clinical care and coordinated treatment/support for pregnant women with opioid use disorder and their infants. Obstetric providers, nurses and hospitals are the first health care contact for most mothers with opioid use disorder (OUD) and need to lead the effort to screen, assess and refer these mothers for OUD treatment.

The two most effective ways to prevent the deaths of mothers suffering from OUD is to get them into medication-assisted behavioral health treatment and make sure they have access to naloxone.

“Screening and referring mothers on opioids for medication assisted treatment and making Naloxone available are essential strategies to preventing maternal deaths,” said Dr. William Sappenfield, professor and director of the Chiles Center.

According to the National Institute of Drug Abuse, naloxone is a medicine that rapidly reverses an opioid overdose. The medication attaches to opioid receptors, reverses and blocks the effects of other opioids. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose.

As the MORE initiative is coming to a close this summer, multiple efforts are underway or have been concluded at the Chiles Center to address this public health issue in partnership with and funding support from the Florida Department of Health (FDOH):

• Drs. Russell Kirby, USF distinguished professor and Marrell endowed chair, and Jason Salemi, associate professor, and their team have worked with FDOH investigators to assess the accuracy of neonatal opioid withdrawal syndrome and maternal OUD claims on hospital inpatient data, as this is the primary data source for the state’s surveillance of this issue. 

• Pregnant women with OUD have difficulty accessing Medication Assisted Treatment. Dr. Jennifer Marshall, associate professor, Dr. Kimberly Fryer, obstetrician-gynecologist with the USF Morsani College of Medicine, and collaborators examined access to treatment and access to prenatal care in Florida for pregnant women with Medicaid using secret shopper methods. Results confirmed many barriers to access, with few callers successful in obtaining an appointment.

• To improve physician providing practices, the FPQC held a waiver training in conjunction with the American College of Obstetricians and Gynecologists, American Society of Addiction Medicine and the Association of Women’s Health, Obstetric and Neonatal Nurses. The FPQC also collaborated with the Tennessee Initiative for Perinatal Quality Care to provide virtual buprenorphine training modules to providers.

• Continue to promote naloxone distribution to patients with opioid use disorder prior to discharge and have worked with the Florida Department of Children and Families’ opioid prevention program to distribute free Narcan to hospitals throughout the state.

• In conjunction with the COPH, they released a video entitled “Naloxone Saves Mothers’ Lives: Angel’s Story”. The video details how Angel, a mother in recovery, had her life saved multiple times by Narcan and how she in turn was able to save another person’s life by carrying a naloxone kit.

• Dr. Cheryl Vamos, associate professor and director of the Center of Excellence in Maternal and Child Health Education, Science and Practice, and colleagues examined promising practices in provider education as a key implementation strategy in perinatal healthcare initiatives, particularly as it pertains to delivering care to women with opioid use disorder.

• The FPQC developed both a prenatal and hospital checklist, as well as educational materials for mother and providers. With the help of Healthy Start Coalitions throughout the state, this information will be disseminated to assist obstetrical providers to recognize, treat and support pregnant women with OUD during prenatal care and at their delivery.

• In an effort to decrease stigma against pregnant women with OUD, FPQC offered a virtual naloxone training to Association of Women’s Health, Obstetric and Neonatal Nurses. Free kits from FDOH were sent to those who completed the workshop.

“We know that a smoker needs to quit 8 to 11 times to be successful. With opioids, regretfully, restarting can be fatal,” Sappenfield said.  “As our new video shows, Naloxone is needed to keep these mothers alive until they make it successfully into recovery.”

Sappenfield also commented that none of FPQC’s work on this initiative is possible without their community partners.

Related articles:

PROVIDE and MORE Virtual Mid-Point Meetings Celebrate Successes and Look to the Future

Hospitals vow to do MORE: FPQC’s new Maternal Opioid Recovery Effort

The Maternal Opioid Recovery Effort Mid-Project Meeting Connects Diverse Stakeholders

Story by Caitlin Keough, USF College of Public Health