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Am Fam Physician. 2023;107(5):547-550

Author disclosure: No relevant financial relationships.

Case Scenario

G.L. is a 32-year-old patient with a history of nicotine use disorder who presents for their first prenatal visit for their third pregnancy. My clinic recently began universal screening for substance use disorders (SUDs) in the prenatal setting, and G.L. has screened positive for nonprescribed opioids. In addition to usual prenatal care, what should I offer G.L. today and in the future?


SUDs, and the associated consequences for individuals and communities, have attracted the attention of physicians, the public, and policy makers. Deaths from drug overdose have continued to rise. In 2020, more than 91,000 deaths were caused by drug overdose in the United States; provisional data estimate 107,622 such deaths in 2021—a 15% increase in one year.1 Pregnant patients are not immune from the overdose epidemic.2 Between 2010 and 2017, the estimated rate of maternal opioid use disorder (OUD) increased from 3.5 to 8.2 per 1,000 delivery hospitalizations, a relative increase of 131%.3 The rate of neonatal abstinence syndrome similarly increased during this period from 4.0 to 7.3 per 1,000 birth hospitalizations, a relative increase of 82%.3

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Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, associate deputy editor.

A collection of Curbside Consultation published in AFP is available at

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