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Initiatives

Perinatal Substance Use

Purpose

The Perinatal Substance Use Initiative was developed to address the significant impact of substance use disorders (SUDs) on maternal morbidity and mortality in Nebraska. SUDs contribute substantially to preventable pregnancy-associated deaths, and the Nebraska Maternal Mortality Review Committee has identified substance use screening, referral to treatment, plans of safe care, and ongoing follow-up as key strategies to improve outcomes. The initiative seeks to address persistent challenges in perinatal substance use care, including inconsistent screening practices, variations in the implementation of federal CARA and CAPTA requirements, inconsistent use of Plans of Safe Care (POSC), and barriers to treatment access. 
 
The initiative also aims to promote equitable care by reducing disparities that disproportionately affect Black, Indigenous, and People of Color (BIPOC) populations and by addressing unique challenges faced by rural communities with limited resources and expertise.

Initiative Goal

In 2024, NPQIC launched a targeted initiative to address substance use disorders (SUDs) during pregnancy, supported by the CDC-RFA-DP22-2207 Statewide Perinatal Quality Collaboratives cooperative agreement. This project aimed to tackle the significant contribution of SUDs to maternal morbidity and mortality in Nebraska.

NPQIC began with a comprehensive baseline assessment of all birthing facilities in Nebraska, revealing significant gaps in policies and practices related to perinatal substance use care. Based on these findings, NPQIC is implementing a multi-faceted strategy:

  1. An educational initiative featuring a webinar series on key topics in perinatal SUD care.
  2. Development of Nebraska-specific resources to support healthcare facilities in implementing best practices.
  3. Ongoing support to facilitate the adoption of evidence-based protocols, improve standardized care, and promote best practices across the state.

A Critical Examination of Neonatal Opioid Exposure in Rural Nebraska

Opioid exposure during pregnancy is an increasingly common problem in the United States. In Nebraska, maternal opioid use varies significantly across regions. Early diagnosis of Neonatal Opioid Withdrawal Syndrome (NOWS) before hospital discharge is crucial for reducing mortality in this high-risk population.

NPQICs Maternal Infant Health Opioid Pilot Project critically examined the incidence of neonatal opioid exposure in rural Nebraska. The project focused on two main objectives.

  1. Educating health care providers and medication dispensaries regarding opioid prescription use in pregnancy
  2. Enhancing primary care providers to implement therapeutic interventions that can improve the health outcomes of families affected by prenatal opioid exposure.

In partnership with the Academy of Pediatrics (AAP), NPQIC also developed an ECHO series to support pediatric primary care practices by raising awareness of prenatal opioid exposure, providing family-focused anticipatory guidance, and enhancing care for affected families.

Project Impact: Our interventions have demonstrated significant outcomes across Nebraska, particularly in high-risk rural areas. Statewide, we observed a decrease in prenatal opioid prescription rates from 4.1% to 2.4%. Concurrently, post-intervention NOWS diagnoses increased by 29% across all regions and counties.

Acknowledgment: This project was made possible by support from the Nebraska Tobacco Settlement Biomedical Research Development Fund (NTSBRDF), the UNMC Office of the Vice Chancellor for Research, and the Rural Drug Addiction Research (RDAR) Center (COBRE: P20GM130461).

Important Dates!

Oct. 30, 2026 - Summit

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