OBGYN and Addiction Medicine
Addiction medicine seeks to prevent, evaluate, diagnose, and treat those who suffer from addiction. It can also help those who have health conditions related to substance abuse, and people who display an unhealthy use of substances and lead them to a path of recovery.
It was formally recognized in 1990, but it wasn’t until 2016 that the American Board of Medical Specialities (ABMS) officially recognized addiction medicine as a medical subspecialty under the American Board of Preventative Medicine.
Because addiction is a chronic medical disease that affects millions, prevention efforts and approaches to treatment are vital. Specialists in addiction medicine are experts with substantial experience in the addiction medicine field–with their vast understanding of the intersectionality between substance abuse disorder and health, they are leaders in this industry.
Dr. Maria Manriquez is one of these leaders and part of the exclusive group of fewer than 200 practitioners certified as both an OB/GYN and addiction medicine doctor, and the only one in the state of Arizona with a private practice.
What is MAT therapy?
MAT therapy–or Medication-Assisted Treatment–is a treatment combining medications such as methadone, buprenorphine, or naltrexone with behavioral therapy and counseling. Extensive research has shown that this combination of therapy and medication can successfully treat substance use disorders and prevent or reduce opioid overdose. MAT therapy allows patients relief of symptoms that can disturb their participation in behavioral health and medical therapies.
How is MAT therapy used?
The medicine used in MAT therapy normalizes the chemistry in the brain, blocking the euphoric effects of opioids which reduces the physiological cravings. This normalizes the body’s functions without the negative withdrawal symptoms.
MAT therapy is still possible with pregnant women and is even encouraged. Pregnancy is a life-changing experience and with a thorough treatment plan, full recovery is possible. Dr. Manriquez and her team have the tools to create an individualized plan to live a life free of addiction. These medications are evidence-based, and not mere substitutions of one drug to another. They are safe to use for months and years, and even a lifetime, making it a great treatment option.
Improve the quality of life for mother and child
Decrease use of opiates and other substances
Decrease the relapse to illicit substances
Improve the birth outcome among pregnant women who have substance use disorders
Decreases the risk of contracting HIV or hepatitis C
What is opioid use disorder?
Opioid use disorder is a chronic and relapsing disorder. Withdrawal even at an acute level is physiologically stressful on the body, with symptoms such as anxiety and hypertension, and harsher symptoms such as nausea, vomiting, and other gastrointestinal issues. This considers a pattern of opioid use that includes an inability to control the use, cravings, and a tolerance.
How is opioid use disorder defined?
Opioid use disorder is distinguished by the constant use of opioids despite the negative consequences of using them. Although genetics play a factor in the propensity towards this disorder, a younger age, being a male, and having less education and income increase the risk of opioid use disorder.
Opioid use in pregnancy has surged in the last decade, with 6.5 babies per 1,000 displaying symptoms of neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS). This is more than four times the rate it was in 2004, and the numbers are rising. When a pregnant woman uses opioids during pregnancy, there is a high risk that her baby will be born addicted and suffer withdrawals, continuing the cycle of addiction.
Is opioid use disorder the same as addiction?
A substance use disorder (or SUD) is classified and defined by the DSM-5 as a chronic but treatable disorder. This differs from a physical dependency in that the body has built up a natural tolerance for a drug and becomes dependent on it to remain pain-free, which is the case for many people who are prescribed pain medication.
On the other hand, a SUD or opioid use disorder results in several symptoms that drive the life of the afflicted: cravings, an inability to control their use of the drug, and continuing to use the drug despite knowing and suffering the devastating consequences. When paired with pregnancy, there is an urgency to abstain from illicit drug use and create a sustainable life for both mother and baby.
Substance abuse disorders in pregnancy
Pregnancy allows an important opportunity to pinpoint and treat women with substance abuse disorders. These disorders affect women across all racial and ethnic groups and socioeconomic classes. Because of this, it is vital to identify any use or dependency on substances as early as possible with early screenings at the first prenatal appointment.
It’s estimated that at least 10% of children born in the United States are affected by illicit drug or alcohol use. Especially in the case of alcohol use disorder children may have complications that span poor attention to severe learning disabilities. With proper treatment and intervention starting in pregnancy, the outcome and livelihood for both mother and child can be better.
How is opioid use disorder treated?
Opioid use disorder has a high rate of relapse. Sudden stoppage of opioids usually leads to severe withdrawal symptoms which lead to relapse. It is recommended to treat this disorder with an opioid agonist. Opioid agonist therapy effectively treats addiction to opioid drugs and involves taking opioid agonists such as methadone or buprenorphine to prevent withdrawal symptoms and reduce the cravings for the drugs.
This treatment is possible during pregnancy and improves the outcome for women enrolled in a comprehensive treatment program. With proper medical support early in the pregnancy, withdrawals may be prevented which will minimize fetal exposure to illicit substances. This puts the mother at the head of her recovery as she’s being guided to a new and sober path.
Opioid agonist therapy
Opioid agonist therapy with buprenorphine during pregnancy is best suited for women who are highly motivated in their recovery and parenting. This includes substance use disorder counseling, pregnancy and parenting education, and pregnancy home visitation programs.
If a woman is not ready to participate in this type of program, then she may benefit from a treatment program that uses methadone and/or buprenorphine, paired with comprehensive treatment services which may include residential treatment. It’s recommended that all women with opioid use disorders receive comprehensive treatment services because medication alone is only a part of recovery treatment.
With opioid agonist therapy, withdrawal may be prevented, resulting in reduced cravings. This can help stabilize the lives of those afflicted. Methadone and buprenorphine replace the shorter-acting opioids that the individual is addicted to with longer-acting opioids. This prevents withdrawal for 24 to 36 hours. Other types of support such as group and individual counseling coupled with this treatment greatly increase the chances of success.
What is the FACOG and FASAM designation?
An obstetrician-gynecologist, or OB/GYN, is a doctor who specializes in health in all stages of pregnancy, including post-pregnancy. Although OB/GYN is considered a singular specialty, it comprises two fields: obstetrics (pre-conception and prenatal care immediately after delivery), and gynecology (the care of all a woman’s health issues).
A doctor with FACOG after their title is certified in obstetrics and gynecology and one with FASAM is certified in addiction medicine. Both indicate a provider is a fellow in their respective college or society, in the case of FACOG (Fellow American College of Obstetricians and Gynecologist) and for FASAM (Fellow American Society of Addiction Medicine).
In addition to having graduated from medical school, completing their residency program, and passing all their exams, a doctor with the FACOG and FASAM initials indicate that they have met additional criteria to qualify as a Fellows of the American Congress of Obstetricians and Gynecologists and the American Society of Addiction Medicine. Not many doctors in the country have both certifications, and Dr. Manriquez is board certified in both ObGyn and Addiction Medicine.
Dr. Manriquez is a uniquely qualified leader
She graduated from the University of Arizona College of Medicine and did her postgraduate training in ObGyn at Banner University Medical Center Phoenix. Dr. Manriquez is a current member of the American College of Obstetricians and Gynecologists (ACOG) FASD group. This group is committed to educating fellow ObGyns to the risks associated with alcohol and other substances in pregnancy.
Locally she is a member of the Maricopa County Safe Healthy Infants and Families Thrive (SHIFT) collaborative task force, the task force’s work focuses on optimizing the health of mothers and babies and keeping families together. She is co-medical director for the Halle Empower and Affirmation Legacy (HEAL) intensive outpatient program. “Empowering women to care for themselves and their children is what we strive for and affirming their success is how we celebrate them.”
Dr. Manriquez serves the American Board of Obstetrics and Gynecology as an oral examiner and content expert. She is a professor in the Department of Obstetrics and Gynecology at the University of Arizona College of Medicine and her clinical practice is at Banner University Medicine Women’s Institute.