August 23, 2022

New initiative aims to prevent the risk of relapse in pregnant patients with opioid and substance use disorder

Joanna Kountanis, M.D., and a multidisciplinary team have received funding from the Michigan Health Endowment Fund to launch an initiative that will provide access to mental health care, alternative pain management options throughout pregnancy, delivery, and postpartum.

Substance misuse and chronic opioid use is rising among pregnant people — and is currently one of the leading causes of maternal mortality up to one year postpartum. But a new initiative from Michigan Medicine and Beaumont Health aims to prevent the risk of substance misuse or relapse, and treat mental health disorders.

Led by Joanna Kountanis, M.D., the initiative recently received a two-year, $500,000 grant from the Michigan Health Endowment Fund for Behavioral Health. 

“In a recent publication looking at pregnancy associated deaths from 33 states, including the State of Michigan, the number of deaths due to drug overdose increased by 190% over the last decade. It is speculated that this may be due to the lack of specialized mental health and substance use services available to this patient population,” said Kountanis, assistant professor of anesthesiology and assistant professor of obstetrics and gynecology. 

“In many other domains in medicine, we aim to optimize a patient’s medical conditions through a multidisciplinary care model. To date, our health systems have not created the same structure to routinely optimize pregnant patients’ mental and behavioral health prior to delivery or to follow patients long term in the postpartum period. Our goal will be to create the infrastructure within our hospital systems to accomplish this.”  

The grant will provide funding for a pilot program to address barriers to this population’s obstetric care. Using a multidisciplinary approach, the program will:

  • Optimize mental health care access prior to birth by expanding MC3/HT2 Perinatal, a state-funded program that allows for mental health screenings, interventions, and access to behavioral therapists via smartphone; 
  • Improve substance and opioid use disorder management by developing streamlined pathways for patients to get coordinated multidisciplinary care in the perinatal period, which includes the time throughout pregnancy and postpartum;
  • Employ a shared decision-making approach for pain control and discussion of alternative pain management protocols during delivery and postpartum that includes consideration of the patient’s psychosocial and other medical conditions; and
  • Increase awareness of barriers and education for medical providers by creating educational materials that address health care inequities faced by pregnant people with opioid or substance use disorder and the psychosocial considerations that impact their medical management.

The initiative also seeks to increase follow-up care throughout the first year postpartum, a critical time during which most maternal deaths occur. Following pregnancy, pilot program participants will continue to have access to MC3/HT2 Perinatal, which will help facilitate mental health care, substance misuse or relapse support, and increased behavioral health and pain screenings within the first two weeks postpartum and at regular intervals throughout the first year.

“Michigan Medicine, Beaumont Health System and their associated hospitals, account for approximately 32,338 annual births — this represents 31% of all births in Michigan. Current estimates are that 7% of pregnant individuals have a prescription opioid at the time of delivery and one in five of those patients reports misuse,” Kountanis said. “If successful, this program has the potential to improve the care for and reduce the risk of maternal overdose death in approximately 2,200 pregnant individuals yearly.” 

Kountanis will collaborate with Maria Muzik, M.D., from the Department of Psychiatry, and Courtney Townsel, M.D., from the Department of Obstetrics and Gynecology.