This guidance publication is intended to support the efforts of states, tribes, and local communities in addressing the needs of pregnant women with opioid use disorders and their infants and families.1 National data show that from 2000 to 2009 the use of opioids during pregnancy increased from 1.19 to 5.63 per 1,000 hospital births (Patrick, Schumacher, Benneyworth, Krans, McAllister, & Davis, 2012). Because of the high rate of opioid use and misuse among all women, including pregnant women, medical, social service, and judicial agencies are having to confront this concern more often and, in some communities, at alarming rates. Opioids are drugs that reduce the intensity of pain signals. The term opiates refers only to natural opium derivatives, and the term opioids refers to drugs that activate opioid receptors, including opiates, heroin, and synthetic opioids (e.g., certain prescription painkillers, such as oxycodone)