1. Interdisciplinary Treatment for Opioid Use Disorder in the UAMS Women’s Mental Health Program – A Case Study
Michael A. Cucciare, PhD and Shona Ray-Griffith, MD
Women’s Mental Health Program
University of Arkansas for Medical Sciences
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2. Disclosures Dr. Cucciare has no disclosures.
Dr. Ray-Griffith receives clinical trial support from Neuronetics and has received clinical trial support from Sage Therapeutics. Neither will be discussed today.

3. Today’s Goals
Briefly describe the UAMS Women’s Mental Health Program (WMHP)
Describe an interdisciplinary approach to treating opioid use disorder
Talk about patient’s outcomes and lessons learned

4. Women’s Mental Health Program (WMHP)
Outpatient psychiatric practice focused on pregnant and postpartum women with neuropsychiatric illnesses, including substance use disorders.

5. Women’s Mental Health Program
Psychiatrists
Shona Ray-Griffith, MD
Jessica L. Coker, MD
Psychologist
Michael Cucciare, PhD
Psychology Intern - rotating
Program Manager
Bettina Knight, RN
Research Assistants
Amber Thomas
Rebecca Stallmann
Clinical Services:
University Women’s Clinic
General Psychiatry for Pregnant and Postpartum Women (including teenagers)
Psychiatric Research Institute
Comorbid mental illness and substance use disorders
Perinatal Mood Disorders
Contact Us/Referrals:
(501) OR

6. Case Study 22 year old woman, Caucasian
19 weeks pregnant (unplanned, wanted)
Not currently employed; some college
No pregnancy complications reported at time of intake
Referred by Maternal-Fetal Medicine (high risk)
Hepatitis C

7. WMHP Intake
Substance use started at age MJ and alcohol; started using cocaine at 15
Current drug use = IV heroin (half gram per day), opioids (dilaudid and roxicodone), methamphetamine, MJ, benzodiazepines, and tobacco
Drug use helps “with withdrawals and to cope with everything”
UDS: + MOP, THC, BUP, OXY, MET/AMP
Motivation to change 10/10
Prior residential SUD treatment x 2; reports seeing “lots” of psychiatrists
Longest period of sobriety was two months

8. WMHP Intake Cont’d Mental Health history:
Felt depressed the past two weeks as well as lots of guilt and shame, self-hate, and hopelessness
BDI = 20 (moderate depression)
Treated for insomnia and anxiety in the past
trazodone, hydroxyzine, gabapentin
Social history:
Lives with mom, uncle, and siblings
FOB plans to be involved
Siblings and FOB all have substance use problems

10. Medication Management
Admitted to inpatient women’s unit for detoxification and induction of buprenorphine
7 day hospitalization
Stabilized on buprenorphine-naloxone 8-2mg SL BID
Followed up with WMHP as an outpatient

11. Behavioral Intervention
Skills-based group treatment: learning about, identifying, and avoiding “triggers”; coping with stress and uncomfortable emotions
Individual counseling:
Relapse Prevention: identify high risk situations that can trigger drug use and enhancing skills for coping, managing lapses
Cognitive Behavioral Therapy for anxiety: identify negative thinking and beliefs, helping patients change unhelpful thinking and behavior to improve mood and functioning

12. Pregnancy “Star” patient Consistently attended all MWHP appointments
Negative urine drug screens (weekly) for many months
Expressed extreme anxiety about the following:
Potential for DHS involvement
Relapse postpartum

13. Delivery Described as “horrible” C-section due to failure to progress
Uncontrolled pain
Baby with no signs of NAS
+ breastfeeding

14. Up to 3 Months Postpartum
Frequent rescheduling of med management and individual counseling
Stressors noted by patient:
reasons being not “feeling well” and “being tired”
suboxone not as effective with withdrawal symptoms
stress and anxiety taking care of baby; relationship problems
Diagnosed with postpartum depression and started on sertraline (Zoloft)
Starting using with friends to avoid stress
Methamphetamines and opioids

16. Overdose Patient did not attend for 1 month
WMHP made check-in phone calls that were not answered
Rumors that she overdosed
1 month later, she contacted physician
She admitted to overdosing (found by her mom unresponsive). Seen in ER and d/ced.
A few days later, she was admitted to ICU for sepsis X 5 days.
She admits to using heroin daily and methamphetamine occasionally
Admitted to inpatient treatment for detoxification & induction

18. Postpartum (post overdose)
Attended treatment regularly
Continued to relapse (positive UDS)
Pt reported high stress (due to caregiving, struggling with relationship with FOB and mother) as reasons for continued use.
Due to positive drug screens, patient was tapered off MAT. Discussed other options. Patient did not return to the WMHP.

19. Lessons Learned
Pt. indicated several months prior to delivery concern about relapse – is there something we could have done differently to prevent relapse?
Residential treatment was discussed as an option but not desired by patient – could we have done something differently to help her consider this option?
Other thoughts?

20. Questions about the Topic
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21. Case Conference and Feedback
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