Treatment of opioid-dependent pregnant women: Clinical and research issues

Jones, Hendrée E.; Martin, Peter; Heil, Sarah H.; Kaltenbach, Karol; Selby, Peter; Coyle, Mara G.; Stine, Susan M.; O’Grady, Kevin E.; Arria, Amelia M.; Fischer, Gabriele

doi:10.1016/j.jsat.2007.10.007

Cited by 169 publications

(171 citation statements)

References 103 publications

(85 reference statements)

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“…Both methadone and buprenorphine are listed by the World Health Organization (WHO) as essential medications to treat OUD; in the United States, both are approved by the US Food and Drug Administration (FDA) for the treatment of opioid dependence/addiction. Methadone and buprenorphine have been shown to increase adherence to antiretroviral therapy in HIV‐infected drug users9 and to increase treatment retention of opioid‐dependent pregnant women 10. Recently, longer‐acting formulations of buprenorphine have been developed, including a monthly injection.…”

Section: Introductionmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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Background and ObjectivesOpioid use disorder (OUD) is a chronic condition with potentially severe health and social consequences. Many who develop moderate to severe OUD will repeatedly seek treatment or interact with medical care via emergency department visits or hospitalizations. Thus, there is an urgent need to develop feasible and effective approaches to help persons with OUD achieve and maintain abstinence from opioids. Treatment that includes one of the three FDA‐approved medications is an evidence‐based strategy to manage OUD. The purpose of this review is to address practices for managing persons with moderate to severe OUD with a focus on opioid withdrawal and naltrexone‐based relapse‐prevention treatment.MethodsLiterature available on PubMed was used to review the evolution of treatment strategies from the 1960s onward to manage opioid withdrawal and initiate treatment with naltrexone.ResultsEmerging practices for extended‐release naltrexone induction include the use of agonist tapers and adjuvant medications. Clinical challenges frequently encountered when initiating this therapy include managing withdrawal and ongoing opioid use during treatment. Clinical factors may inform decisions regarding patient selection and length of naltrexone treatment, such as recent opioid use and patient preferences.Conclusions and Scientific SignificanceTreatment strategies to manage opioid withdrawal have evolved, but many patients with OUD do not receive medication for the prevention of relapse. Clinical strategies for induction onto extended‐release naltrexone are now available and can be safely and effectively implemented in specialty and select primary care settings. (© 2018 The Authors. The American Journal on Addictions Published by Wiley Periodicals, Inc. on behalf of The American Academy of Addiction Psychiatry (AAAP);27:177–187)

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Section: Introductionmentioning

confidence: 99%

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

et al. 2018

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“…Additional opioid will be required for any postoperative pain, as with any opioid-tolerant patient, and the infant will require high-level neonatal care because of the risk of withdrawal (Ludlow et al, 2007;Jones et al, 2008). Opioid requirements during labour may not be significantly increased although methadone-maintained patients in this study did have higher pain scores .…”

Section: Management Of Acute Pain In Pregnant Patients With An Addictmentioning

confidence: 84%

“…Opioid requirements during labour may not be significantly increased although methadone-maintained patients in this study did have higher pain scores . Those taking buprenorphine will also have higher opioid requirements after surgery, and the newborn is still at risk (albeit maybe a lower risk) of withdrawal (Ludlow et al, 2007); again, opioid requirements during labour may not be increased (Jones et al, 2008). Both methadone and buprenorphine should be continued without interruption or, if the patient cannot take oral medications, then an alternative route (or opioid) should be used (Jones et al, 2008).…”

Section: Management Of Acute Pain In Pregnant Patients With An Addictmentioning

confidence: 99%

Safety of opioid patch initiation in Australian residential aged care

Gadzhanova

Roughead

Pont

2015

Medical Journal of Australia

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Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

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“…It is widely believed that intrauterine death or fetal compromise is due to the "bingeing" or drastic fluctuations in serum levels of opiates or cocaine associated with "street" use [12]. Methadone substantially minimizes the peak and trough in maternal serum opioid levels that typically occur with repeat use of short-acting opioids such as heroin, thereby reducing the harm that the fetus encounters as a result of repeated intoxication and withdrawal [13]. Methadone use during pregnancy has been associated with improved prenatal care, [14] longer gestation, [15] higher birthweight, [16] and increased rates of infants discharged home in the care of their mothers [17].…”

Section: Introductionmentioning

confidence: 99%

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

Janssen¹,

Kelly²,

Thiessen³

et al. 2013

Deutsche Zeitschrift für Akupunktur

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Background: The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems. Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns. Methods: We randomly assigned chemically dependent pregnant women at BC Women's Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care. By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal. Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care. Results: We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group. Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant. Conclusions: Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone. Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns. Clinical Trial Registration: http://www.clinicaltrials.gov registry: W05-0041

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Treatment of opioid-dependent pregnant women: Clinical and research issues

Cited by 169 publications

References 103 publications

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Antagonists in the medical management of opioid use disorders: Historical and existing treatment strategies

Safety of opioid patch initiation in Australian residential aged care

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

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