Standards for private organizations

2020 Edition

Opioid Treatment (OTP) 14: Opioid Treatment During Pregnancy

The organization provides comprehensive, coordinated treatment services that address medical, prenatal, obstetrical, psychosocial, and addiction concerns for pregnant women.
2020 Edition

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Individuals who participate in Opioid Treatment Programs improve social, emotional, and vocational functioning, achieve optimal productivity, and attain the recovery they seek.
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Procedures that address prenatal care for pregnant women
  • Procedures for withdrawal from methadone for pregnant women
  • Procedures for evaluating newborns
  • Information and education regarding potential risks for pregnant women
  • Information about education and support groups
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records


OTP 14.01

The organization addresses the special needs of pregnant women, including: 
  1. maintenance at the pre-pregnancy medication dose for women who become pregnant during treatment; 
  2. dosing protocols for newly admitted pregnant women that are equivalent to those used for all other persons served;
  3. carefully monitoring the methadone dose, especially during the third trimester of pregnancy; and
  4. provision of treatment services for pregnant women with concurrent HIV infection.


OTP 14.02

The organization coordinates and provides prenatal care for pregnant women, either directly or by referral to outside medical services, to address their special needs including the need for a health evaluation.

Fundamental Practice

OTP 14.03

Pregnant women who receive opioid treatment are informed about the possible risks associated with:
  1. the effects of treatment on unborn children;
  2. continued use of drugs; and
  3. withdrawal from opioid treatment medication during pregnancy.

Fundamental Practice

OTP 14.04

When withdrawal from opioid treatment medication is initiated for pregnant women, such withdrawal:
  1. is conducted under the supervision of a physician;
  2. takes place, when possible, in a prenatal unit equipped with fetal monitoring equipment and with regular fetal assessments; and
  3. is not initiated before 14 weeks, nor after 32 weeks, gestation.


OTP 14.05

The organization provides parent education and support groups, directly or by referral, that address:
  1. healthy mother-infant interactions;
  2. signs, symptoms, and effects of neonatal abstinence syndrome; and
  3. resources to treat neonatal abstinence syndrome.
Examples: Parent education to improve mother-infant interactions can address topics related to maternal, physical, and dietary care, including for example the promotion of breast-feeding.

Fundamental Practice

OTP 14.06

The program is responsible for ensuring that newborns are medically evaluated if signs or symptoms of neonatal abstinence syndrome appear following hospital discharge.


Programs that do not have responsibility for the care and treatment of newborns should provide education, information, and referral to ensure that mothers who have infants that may be susceptible to health issues seek comprehensive evaluation and treatment for the infant.