Challenges and opportunities during the COVID-19 pandemic: Treating patients for substance use disorders during the perinatal period.

The United States of America faces an opioid use disorder epidemic and growing rates of alcohol and other substance use disorders within the coronavirus disease 2019 (COVID-19) pandemic. Pregnant and post-pregnant individuals are also adversely affected by the epidemic in a pandemic. Physical safety measures preventing COVID-19 also trigger initiation, resumption or intensification of alcohol and substance use among some individuals, including pregnant and post-pregnant people. Collectively, increasing alcohol use and the opioid epidemic interwoven within the COVID-19 pandemic warrant attention among all people, including pregnant and post-pregnant people. Sudden service delivery transitions during the COVID-19 pandemic not only reduced access to opioid use disorder treatment care but also created engagement issues. Such obstacles include: (1) "digital divide" issues such as lack of internet or broadband access; during visits; (2) virtual visit privacy concerns; (3) needing to parent during virtual appointments, (4) rapport building in the virtual environment and (5) ensuring access to naloxone when supplies cannot be handed out. Virtual platforms also present positive opportunities for treatment. They are time efficient, eliminate transportation barriers, and may offer more privacy. The substance use disorder treatment field has undergone exiting and dynamic changes to continue to care for those with substance use disorders. Meaningful change is urgently needed in the intersecting areas of minoritized health disparities, substance use disorder treatment, and pregnancy status. An unprecedented opportunity exists to dramatically transform standard care approaches during the pandemic to help optimize care for all patients, including pregnant and post-pregnant people.