Standards for public agencies

2020 Edition

Opioid Treatment (PA-OTP) 14: Opioid Treatment During Pregnancy

The agency 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.
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.

Partial Implementation, Concerning Performance
A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  

  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed service delivery infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
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

PA-OTP 14.01

The agency 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.

PA-OTP 14.02

The agency 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

PA-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

PA-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.

PA-OTP 14.05

The agency 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

PA-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.