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The Comprehensive Addiction and Recovery Act: Opioid Use Disorder and Midwifery Practice

Murphy, Jeanne, PhD, CNM; Goodman, Daisy, DNP, CNM; Johnson, M., Christina, MS, CNM; Terplan, Mishka, MD, MPH

doi: 10.1097/AOG.0000000000002493
Contents: Current Commentary

The federal response to the opioid use disorder crisis has included a mobilization of resources to encourage office-based pharmacotherapy with buprenorphine, an effort culminating in the 2016 Comprehensive Addiction and Recovery Act, signed into law as Public Law 114-198. The Comprehensive Addiction and Recovery Act was designed to increase access to treatment with special emphasis on services for pregnant women and follow-up for infants affected by prenatal substance exposure. In this effort, the Comprehensive Addiction and Recovery Act laudably expands eligibility for obtaining a waiver to prescribe buprenorphine to nurse practitioners and physician assistants. However, certified nurse–midwives and certified midwives, who care for a significant proportion of pregnant and postpartum women and attend a significant proportion of births in the United States, were not included in the Comprehensive Addiction and Recovery Act legislation. In this commentary, we argue that an “all-hands” approach to providing office-based medication-assisted treatment for opioid use disorder is essential to improving access to treatment. Introduced in the House of Representatives in September 2017, the Addiction Treatment Access Improvement Act (H.R. 3692) would allow midwives to apply for the federal waiver to prescribe buprenorphine and is supported by the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives. We support this change and encourage the U.S. Congress to act quickly to allow midwives to prescribe medication-assisted treatment for pregnant women with opioid use disorder.

Certified nurse–midwives and certified midwives are positioned to provide high-quality services for pregnant women with opioid use disorders as members of multidisciplinary treatment teams.

George Washington University School of Nursing, Washington, DC; Dartmouth Hitchcock Medical Center Perinatal Addiction Treatment Program, Hanover, New Hampshire; the American College of Nurse-Midwives, Silver Spring, Maryland; and Virginia Commonwealth University, Richmond, Virginia.

Corresponding author: Jeanne Murphy, PhD, CNM, the George Washington School of Nursing, 1919 Pennsylvania Avenue NW, Suite 500, Washington, DC 20052; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

This article was written while Dr. Murphy was employed at the Patient-Centered Outcomes Research Institute (PCORI). The opinions presented in this article are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee, nor of any of the other institutions referenced.

Each author has indicated that she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.