Inclusion of Positive Self-reporting by Mothers of Substance Exposed Neonates Increases the Predictability of NAS Severity Over Toxicology Alone

Roth, Danielle; Loudin, Sean; Andrews, L. D.; Evans, Joseph; Davies, Todd H.

doi:10.1007/s10995-019-02871-9

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…However, compared to morphine or methadone, buprenorphine is preferred for medication-assisted treatment (MAT) programs for pregnant women [64] due to its fewer side effects and less abuse liability [65]. As a result, a recent survey of patients revealed that developing fetuses are now much more likely to be exposed to buprenorphine than any other opioids/opiates [66]. Despite the benefits of buprenorphine for the acute treatment of NAS [67], as well as preclinical evidence that shows less severe cognitive impairments with the use of buprenorphine versus morphine and methadone [68][69][70], there remains a concern of negative developmental outcomes.…”

Section: Discussionmentioning

confidence: 99%

Abnormal morphology and synaptogenic signaling in astrocytes following prenatal opioid exposure

Niebergall,

Weekley,

Mazur

et al. 2024

Preprint

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In recent decades, there has been a dramatic rise in the rates of children being born afterin uteroexposure to drugs of abuse, particularly opioids. Opioids have been shown to have detrimental effects on neurons and glia in the central nervous system (CNS), but the impact of prenatal opioid exposure (POE) on still-developing synaptic circuitry is largely unknown. Astrocytes exert a strong influence on synaptic development, secreting factors that both promote and inhibit synapse formation and neuronal maturation in the developing CNS. Here, we investigated the effects of the partial µ-opioid receptor agonist, buprenorphine, on astrocyte synaptogenic signaling and morphological development in cortical cell culture. Acute buprenorphine treatment had no effect on excitatory synapse number in astrocyte-free neuron cultures. In conditions where neurons shared culture media with astrocytes, buprenorphine attenuated the synaptogenic capabilities of astrocyte-secreted factors. Neurons cultured from drug-naïve mice showed no change in synapses when treated with factors secreted by astrocytes from POE mice. However, this same treatment was synaptogenic when applied to neurons from POE mice, suggestive of a complex neuroadaptive response that maintains synaptogenic pathways in the face of impaired astrocyte signaling. In addition to promoting morphological and connectivity changes in neurons, POE exerted a strong influence on astrocyte development, disrupting their structural maturation and promoting the accumulation of lipid droplets (LD), suggestive of a maladaptive stress response in the developing nervous system.

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Section: Discussionmentioning

confidence: 99%

Abnormal morphology and synaptogenic signaling in astrocytes following prenatal opioid exposure

Niebergall,

Weekley,

Mazur

et al. 2024

Preprint

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“…However, the Timeline Followback is an adequately reliable measure that allows for more nuanced measurement of substance exposure than periodic urine screens. Further, there are circumstances in which women may self‐report substance use that is not reliably detected by toxicology, such as heroin (Roth et al., 2020). In addition, maternal psychopathology during pregnancy and beyond may impact infant autonomic regulation.…”

Section: Discussionmentioning

confidence: 99%

Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity

Tabachnick,

Eiden,

Labella

et al. 2023

Psychophysiology

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Prenatal opioid exposure has been associated with developmental problems, including autonomic nervous system dysregulation. However, little is known about the effects of prenatal opioid exposure on the autonomic nervous system beyond the first days of life, particularly across both the parasympathetic and sympathetic branches, and when accounting for exposure to other substances. The present study examined the effects of prenatal exposure to opioid agonist therapy (OAT, e.g., methadone) and other opioids on infant autonomic nervous system activity at rest and in response to a social stressor (the Still‐Face Paradigm) at six months among 86 infants varying in prenatal opioid and other substance exposure. Results indicated that OAT and other opioids have unique effects on the developing autonomic nervous system that may further depend on subtype (i.e., methadone versus buprenorphine) and timing in gestation. Results are discussed in the context of theoretical models of the developing stress response system.

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“…Reporting of drugs could have been influenced by questions asked by the ambulance service staff, individual recall and accuracy of self-report, although there is some evidence that self-report may have additional benefit over toxicology in some situations. 52 Agreement between urine toxicology and self-report, in patients admitted to hospital, has been shown to be generally high, but lower for opioids, benzodiazepines and heroin. 53 Indeed, this may explain the lack of reporting of prescription opioids.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of non-fatal overdoses and associated risk factors in patients attending a specialist community-based substance misuse service

Ghose

Cowden

Veluchamy

et al. 2022

British Journal of Pain

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Introduction There are concerns about rising drug-related deaths and the potential contribution of prescription analgesics. There is limited understanding regarding the role of prescription analgesics in non-fatal overdoses (NFODs), nor is there a good understanding of what factors are associated with more severe overdose. Objectives To explore risk factors and characteristics of NFODs among people attending a specialist community-based substance misuse service. Methods After Caldicott approval, data on NFODs, in people attending the Tayside Substance Misuse Service (TSMS), were extracted from the Scottish Ambulance Service database, along with opioid replacement therapy (ORT) prescribing data. Statistical analysis was performed using R studio and Microsoft Excel. Results 557 people (78% [434/556] male, mean age ± standard deviation 38.4 ± 7.95) had an NFOD. Repeat NFODs were more likely in males compared to females ( p < .0065). Males were more likely to be administered naloxone (OR = 1.94, 95% CI = 1.10–3.40, p < .02). NFODs at home were more likely to be moderate to severe (categorized by Glasgow Comma Scale [ p < .02, OR = 4.95, 95% CI = 1.24–24.38]). Methadone (321/557, 57.63%), benzodiazepines (281/557, 50.45%) and heroin (244/557, 43.81%) were the commonest substances: prescribed methadone overdose was more likely than buprenorphine ( p < .00001). Opioids and benzodiazepines were often taken together (275/557, 49.40%), with almost all gabapentinoid NFODs also involving opioids (60/61, 98.40%). Conclusions Polysubstance use with opioids prescribed for ORT, such as methadone, is highly likely to be implicated in NFOD, with males being at the highest risk of severe and repeat NFOD. Future work should focus on strategies to further reduce NFODs.

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Inclusion of Positive Self-reporting by Mothers of Substance Exposed Neonates Increases the Predictability of NAS Severity Over Toxicology Alone

Cited by 10 publications

References 22 publications

Abnormal morphology and synaptogenic signaling in astrocytes following prenatal opioid exposure

Abnormal morphology and synaptogenic signaling in astrocytes following prenatal opioid exposure

Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity

Characteristics of non-fatal overdoses and associated risk factors in patients attending a specialist community-based substance misuse service

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