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Mantri S, Cheng AC, Saia K, Shrestha H, Amgott R, Bressler J, Werler MM, Carter G, Jones HE, Wachman EM. Neurobehavioral outcomes of infants exposed to buprenorphine-naloxone compared with naltrexone during pregnancy. Early Hum Dev 2024; 194:106051. [PMID: 38815498 DOI: 10.1016/j.earlhumdev.2024.106051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/26/2024] [Accepted: 05/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Naltrexone is a medication used to treat both opioid and alcohol use disorder with limited experience in pregnant individuals, particularly in comparison to more commonly utilized treatments such as buprenorphine-naloxone. The long-term outcomes of infants exposed to naltrexone has not been previously examined. AIMS To compare the neurobehavioral outcomes of naltrexone versus buprenorphine-naloxone exposed infants. STUDY DESIGN Multi-centered prospective cohort study. SUBJECTS Pregnant people on prescribed buprenorphine-naloxone or naltrexone were enrolled during pregnancy and the dyad followed until 12 months after delivery. OUTCOME MEASURES Infants were evaluated at 4-6 weeks corrected gestational age (CGA) using the NICU Neonatal Neurobehavioral Scale (NNNS) and at the 12-month CGA visit using the Ages and Stages Questionnaire, Third Edition (ASQ-3). RESULTS There were 7 dyads in the naltrexone group and 34 in the buprenorphine-naloxone group. On the NNNS, infants exposed to naltrexone had higher median scores for arousal and excitability, and lower median scores for attention and regulation at 4-6 weeks CGA compared to the buprenorphine-naloxone group. None of the infants in the naltrexone group were monitored for NOWS and had shorter length of hospital stay compared with the buprenorphine-naloxone group. Although no statistically significant differences were observed, more infants in the buprenorphine-naloxone group were identified as at risk for development delays in the communication, problem solving, and personal social domains of the ASQ-3 at 12 months CGA. Results should be interpreted with caution given this study's small sample size and lack of a prospective comparison cohort. CONCLUSIONS In this small cohort, there are differences noted in infant neurobehavior by NNNS at 4-6 weeks of age when comparing the buprenorphine-naloxone and naltrexone groups. At 12 months, ASQ-3 scores were similar but with percentage differences in potential development delay risk observed between the two groups. Larger cohort studies are needed to determine the long-term child outcomes after naltrexone exposure in pregnancy.
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Affiliation(s)
- Saaz Mantri
- Boston University Chobanian & Avedisian School of Medicine, 72 East Concord Street, Boston, MA, United States of America.
| | - An-Chiao Cheng
- Department of Pediatrics, Boston Medical Center, 670 Albany Street, Boston, MA 02118, United States of America.
| | - Kelley Saia
- Department of Obstetrics & Gynecology, Boston Medical Center, One Boston Medical Center Place, Boston, MA 02118, United States of America.
| | - Hira Shrestha
- Department of Neurology, McCance Center for Brain Health, Massachusetts General Hospital, 399 Revolution Drive, Somerville, MA 02145, United States of America.
| | - Rachel Amgott
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, United States of America.
| | - Jonathan Bressler
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, United States of America.
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, United States of America.
| | - Ginny Carter
- Department of Obstetrics & Gynecology, University of North Carolina, 410 N Greensboro St, Carrboro, NC 27510, United States of America.
| | - Hendree E Jones
- Department of Obstetrics & Gynecology, University of North Carolina, 410 N Greensboro St, Carrboro, NC 27510, United States of America.
| | - Elisha M Wachman
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, United States of America.
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Wachman EM, Saia K, Bressler J, Werler M, Carter G, Jones HE. Case Series of Individuals Treated With Naltrexone During Pregnancy for Opioid and/or Alcohol Use Disorder. J Addict Med 2024; 18:288-292. [PMID: 38354121 PMCID: PMC11150101 DOI: 10.1097/adm.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
OBJECTIVE There is a lack of knowledge about the relative safety and efficacy of naltrexone for the treatment of pregnant individuals with opioid and/or alcohol use disorder, including the range of outcomes, in both the pregnant individual and the infant, over the course of peripartum period. Our objective was to describe these outcomes in a cohort of pregnant individuals on naltrexone. METHODS In this prospective case series, 7 pregnant individuals with opioid use disorder (OUD) or alcohol use disorder (AUD) treated with naltrexone were followed from pregnancy through 12 months after delivery. Clinical treatment protocols and outcomes related to safety and efficacy during pregnancy, delivery, and the postpartum period are described. RESULTS There were 4 pregnant individuals with OUD and 3 with AUD, of which 3 were managed with oral and 4 with extended-release naltrexone. The mean gestational age at study enrollment was 21.7 (SD, 12) weeks. Of the 7 participants, there was no return to nonprescribed opioid use and 2 who experienced a return to alcohol use over the course of the study. All individuals delivered vaginally at a mean of 37 weeks gestation without any peripartum pain difficulties. Five of the individuals (71.4%) remained on naltrexone 12 months after delivery. There were no reported fetal anomalies and one preterm delivery. None of the infants developed neonatal opioid withdrawal syndrome. CONCLUSIONS For pregnant individuals with OUD or AUD treated with naltrexone, there were low rates of return to nonprescribed use and reassuring pregnant person and infant outcomes to 12 months postpartum.
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Affiliation(s)
- Elisha M Wachman
- From the Department of Pediatrics, Boston Medical Center, Boston MA (EMW, JB); Department of Obstetrics and Gynecology, Boston Medical Center, Boston MA (KS); Boston University School of Public Health, Boston MA (MW); Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC (GC, HEJ)
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Smith D, Sullivan R, Allen EC, Pradhan S, Zhu J, Oji-Mmuo CN. Evaluating the Effect of Maternal Opioid Maintenance Dose on the NOWS-COS Outcome Criteria: A Pilot Study. Clin Pediatr (Phila) 2024:99228241246647. [PMID: 38629767 DOI: 10.1177/00099228241246647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
This retrospective cohort study included 77 mother-infant dyads that delivered term pregnancies at a single tertiary care institution. The primary objective was to investigate whether maternal dose of opioid maintenance therapy during pregnancy affects infant outcomes. All infants had prenatal exposure to opioid maintenance therapies. Maternal dose was converted into morphine milligram equivalents (MMEs) and stratified into high- (MME >1000 mg) and low-dose groups (MME ≤1000 mg). Associations between infant outcomes and MME dosage were examined using Wilcoxon rank-sum and Fisher's Exact tests. Days to symptom control were significantly higher in the high MME group (5 days vs 2.8 days, P = .016). Rates of developmental delay at 24 months were higher in the high MME group (21.2% vs 4.5%, P = .0335). Maternal MME did not predict need for NOWS treatment. Higher MME-exposed infants should have optimized nonpharmacologic interventions for consolation and be increasingly observed for signs of developmental delay.
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Affiliation(s)
- Danielle Smith
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Rhea Sullivan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Emma C Allen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Sandeep Pradhan
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Junjia Zhu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christiana N Oji-Mmuo
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Mallinson DC, Kuo HHD, Kirby RS, Wang Y, Berger LM, Ehrenthal DB. Maternal opioid use disorder and infant mortality in Wisconsin, United States, 2010-2018. Prev Med 2024; 181:107914. [PMID: 38408650 PMCID: PMC10947857 DOI: 10.1016/j.ypmed.2024.107914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The difference in infant health outcomes by maternal opioid use disorder (OUD) status is understudied. We measured the association between maternal OUD during pregnancy and infant mortality and investigated whether this association differs by infant neonatal opioid withdrawal syndrome (NOWS) or maternal receipt of medication for OUD (MOUD) during pregnancy. METHODS We sampled 204,543 Medicaid-paid births from Wisconsin, United States (2010-2018). The primary exposure was any maternal OUD during pregnancy. We also stratified this exposure on NOWS diagnosis (no OUD; OUD without NOWS; OUD with NOWS) and on maternal MOUD receipt (no OUD; OUD without MOUD; OUD with <90 consecutive days of MOUD; OUD with 90+ consecutive days of MOUD). Our outcome was infant mortality (death at age <365 days). Demographic-adjusted logistic regressions measured associations with odds ratios (OR) and 95% confidence intervals (CI). RESULTS Maternal OUD was associated with increased odds of infant mortality (OR 1.43; 95% CI 1.02-2.02). After excluding infants who died <5 days post-birth (i.e., before the clinical presentation of NOWS), regression estimates of infant mortality did not significantly differ by NOWS diagnosis. Likewise, regression estimates did not significantly differ by maternal MOUD receipt in the full sample. CONCLUSIONS Maternal OUD is associated with an elevated risk of infant mortality without evidence of modification by NOWS nor by maternal MOUD treatment. Future research should investigate potential mechanisms linking maternal OUD, NOWS, MOUD treatment, and infant mortality to better inform clinical intervention.
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Affiliation(s)
- David C Mallinson
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America.
| | - Hsiang-Hui Daphne Kuo
- Department of Obstetrics and Gynecology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Russell S Kirby
- The Chiles Center, College of Public Health, University of South Florida, Tampa, FL, United States of America
| | - Yi Wang
- Silberman School of Social Work, Hunter College, New York, NY, United States of America
| | - Lawrence M Berger
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Deborah B Ehrenthal
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States of America; Social Science Research Institute, The Pennsylvania State University, University Park, PA, United States of America
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Miller MR, MacMillan KDL. Growing together: Optimization of care through quality improvement for the mother/infant dyad affected by perinatal opioid use. Semin Perinatol 2024; 48:151907. [PMID: 38702266 DOI: 10.1016/j.semperi.2024.151907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
The care of the dyad affected by opioid use disorder (OUD) requires a multi-disciplinary approach that can be challenging for institutions to develop and maintain. However, over the years, many institutions have developed quality improvement (QI) initiatives aimed at improving outcomes for the mother, baby, and family. Over time, QI efforts targeting OUD in the perinatal period have evolved from focusing separately on the mother and baby to efforts addressing care of the dyad and family during pregnancy, delivery, and postpartum. Here, we review recent and impactful QI initiatives that serve as examples of work improving outcomes for this population. Further, we advocate that this work be done through a racial equity lens, given ongoing inequities in the care of particularly non-white populations with substance use disorders. Through QI frameworks, even small interventions can result in meaningful changes to the care of babies and families and improved outcomes.
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Affiliation(s)
- Megan R Miller
- Obstetrics & Gynecology, UMMS-Baystate Medical Center, United States.
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Coffey MJ, Weng M, Jimes C, Brigham S, Lira MC. Telehealth Treatment for Opioid Use Disorder During Pregnancy. JAMA Netw Open 2024; 7:e242463. [PMID: 38483393 PMCID: PMC10940952 DOI: 10.1001/jamanetworkopen.2024.2463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 03/17/2024] Open
Abstract
This cohort study evaluates opioid use disorder (OUD) treatment and pregnancy outcomes among pregnant patients receiving OUD care through a multistate telemedicine program in the US.
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Affiliation(s)
- M. Justin Coffey
- Workit Labs, Workit Health, Ann Arbor, Michigan
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Maxwell Weng
- Workit Labs, Workit Health, Ann Arbor, Michigan
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | | | | | - Marlene C. Lira
- Workit Labs, Workit Health, Ann Arbor, Michigan
- DrPH Program, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Goss T, Esguerra J, Newman C, Patrick J, Templeton K. Inclusion of Sex and Gender Differences in U.S. State Action Plans for Opioid Use and Opioid Use Disorder. J Womens Health (Larchmt) 2024; 33:275-282. [PMID: 38064491 DOI: 10.1089/jwh.2023.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
Background: States have developed action plans to address the "opioid crisis" over the past several years. While sex- and gender-based differences have been identified in complications of opioid use, risks of addiction to opioids, barriers to treatment of opioid use disorder, and associated stigma, it is unknown if or to what extent opioid plans consider or account for these differences. The objectives of this study were to analyze U.S. state opioid action plans and their inclusion of sex- and gender-specific concerns. Methods: A content analysis of 49 state plans was conducted in June 2020, assessing their inclusion of 14 variables covering provider education, pregnancy-related, and sex- or gender-based differences in opioid addiction and treatment. Results: Neonatal opioid withdrawal syndrome was the most common variable, noted in 57% of plans. Only 14% included pregnancy-related stigma, and 4% identified gender-specific stigma. Contraceptives and family-planning were included in 12% and 10% of plans, respectively. Two states included more than half of the variables and five plans made no mention of sex or gender differences. Conclusions: Few state plans contained sex- or gender-specific information, and those that did focused almost exclusively on childbearing, excluding other unique considerations of opioid-using-women of all ages. The results of this study could improve the care of women using opioids by informing the strategies of state agencies and impacting legislative efforts for prevention initiatives, substance use disorder treatment, and law enforcement programs.
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Affiliation(s)
- Taylor Goss
- Pennsylvania State University College of Medicine, State College, Pennsylvania, USA
| | - Jody Esguerra
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Connie Newman
- Department of Medicine, NYU School of Medicine, New York, New York, USA
| | - Jessica Patrick
- Department of Pediatrics, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Kimberly Templeton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Valentine SE, Godfrey LB, Gellatly R, Paul E, Clark C, Giovannini K, Saia KA, Nillni YI. Supporting the implementation of written exposure therapy for posttraumatic stress disorder in an obstetrics-substance use disorder clinic in the Northeastern United States. SSM - MENTAL HEALTH 2023; 4:100256. [PMID: 38645900 PMCID: PMC11027481 DOI: 10.1016/j.ssmmh.2023.100256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Pregnant people with comorbid posttraumatic stress disorder (PTSD) and substance use disorder (SUD) constitute a highly vulnerable population. PTSD and SUD confer risks to both the pregnant person and the fetus, including a host of physical and mental health consequences. When PTSD and SUD co-occur, potential negative impacts are amplified, and the symptoms of each may exacerbate and maintain the other. Pregnancy often increases engagement in the healthcare system, presenting a unique and critical opportunity to provide PTSD and SUD treatment to birthing people motivated to mitigate risks of losing custody of their children. This paper presents implementation process outcomes of Written Exposure Therapy (WET), a brief, scalable, and sustainable evidence-based PTSD treatment delivered to pregnant persons receiving care in an integrated obstetrical-addiction recovery program at Boston Medical Center. Trial participants (N = 18) were mostly White, non-Hispanic (61.1%), not currently working (77.8%), had a high school or lower level of education (55.5%), had an annual household income less than $35,000 (94.4%), and were living in a substance use residential program (55.6%). We examined intervention feasibility, acceptability, appropriateness, adoption; barriers and facilitators to implementation; and feedback on supporting uptake and sustainability of the intervention using coded qualitative sources (consultation field notes [N = 47] and semi-structured interviews [N = 5]) from providers involved in trial planning and treatment delivery. Results reflected high acceptability, appropriateness, and adoption of WET. Participants described system-, provider-, and patient-level barriers to implementation, offered suggestions to enhance uptake, but did not raise concerns about core components of the intervention. Findings suggest that WET is an appropriate and acceptable PTSD treatment for this difficult-to-reach, complex population, and has the potential to positively impact pregnant persons and their children.
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Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Laura B. Godfrey
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Resham Gellatly
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Immigrant and Refugee Health Center, Boston Medical Center, Boston, MA, USA
| | - Emilie Paul
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Caitlin Clark
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Karissa Giovannini
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
| | - Kelley A. Saia
- Department of Obstetrics & Gynecology, Boston Medical Center, Boston, MA, USA
- Department of Obstetrics & Gynecology, Boston University School of Medicine, Boston, MA, USA
| | - Yael I. Nillni
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- National Center for PTSD, Women’s Health Sciences Division at VA Boston Healthcare System, Boston, MA, USA
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Simon J, Guynn I, Thompson M, Hambright S, Jones C, Lich KH. Strengthening the System Supporting Perinatal People with Substance Use Disorder in the Midwest Using Group Model Building. Matern Child Health J 2023; 27:128-142. [PMID: 37477728 PMCID: PMC10692270 DOI: 10.1007/s10995-023-03751-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Providing comprehensive, evidence-based care to perinatal people with substance use disorders (SUD) requires multi-stakeholder collaboration and alignment. The National Maternal and Child Health Workforce Development Center facilitated a system-strengthening process with the Midwest substance use in pregnancy (SUPper) club, a regional collaborative of health care providers, state public health agencies, and community-rooted organizations. METHODS Facilitators led a 2 day group model building (GMB) workshop with 20 participants and two semi-structured interviews. Workshop participants were invited to complete an evaluation. RESULTS Two primary trends were identified as priorities for change: (1) Birthing people's perception/experience of stigma and (2) The Midwest SUPper Club's reach and influence. Three causal loop diagrams (CLDs) were created to capture the interconnected dynamics of the Midwest perinatal SUD system: (1) the influence of stigma on maternal and infant health outcomes, (2) the role of clinic, organizational, and state policies, and (3) the impact of workforce education and evidence-based practices on care. From the CLDs, four priorities for action emerged: (1) align and promote shared mental models across stakeholders, (2) expand education and training opportunities for the perinatal SUD workforce, (3) strengthen systems infrastructure to support care navigation for patients and providers, and (4) collaboratively identify evidence-based practices that meet regional needs. All evaluation respondents reported that the workshop supported the development of a shared mental model. DISCUSSION The GMB process strengthened collaboration and advanced strategic planning for the SUPper Club. GMB can be further utilized among diverse stakeholders across MCH systems to create shared mental models and accelerate collaborative planning efforts.
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Affiliation(s)
- Jessica Simon
- Association of Maternal and Child Health Programs, 1825 K Street NW, Suite 250, Washington, DC, 20006, USA.
- Department of Maternal and Child Health, National MCH Workforce Development Center, University of North Carolina at Chapel Hill, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA.
| | - Isabella Guynn
- Department of Maternal and Child Health, National MCH Workforce Development Center, University of North Carolina at Chapel Hill, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavaran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| | - Meagan Thompson
- Susan S. Morrison School of Nursing, University of St. Thomas, 2115 Summit Ave, St. Paul, MN, 55105, USA
| | - Sarah Hambright
- Department of OBGYN, Maternal Substance Use Disorder Clinic, University of Iowa, 200 Hawkins Dr, Iowa City, IA, 52242, USA
| | - Cresta Jones
- Department of Obstetrics, Gynecology and Women's Health, University of Minnesota Medical School, 606 24th Ave S, Suite 401, Minneapolis, MN, 55455, USA
| | - Kristen Hassmiller Lich
- Department of Maternal and Child Health, National MCH Workforce Development Center, University of North Carolina at Chapel Hill, 412 Rosenau Hall, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105E McGavaran-Greenberg Hall, Chapel Hill, NC, 27599, USA
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Deflorimonte C, Glissendorf V, Hofer J, Cai A, Iannella N, Boateng JO, Carter G, Saia KA, Jones HE, Wachman EM. National Provider Survey: Use of Naltrexone for Pregnant Individuals with Substance Use Disorders. J Addict Med 2023; 17:736-738. [PMID: 37934548 PMCID: PMC10873530 DOI: 10.1097/adm.0000000000001225] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES A national survey evaluated the availability of naltrexone as a treatment for alcohol use disorder and/or opioid use disorder for pregnant individuals. Provider perceptions of barriers to treatment with naltrexone during pregnancy were also examined. METHODS Sites were selected from a national registry of naltrexone prescribers (N = 5208). A 10% sampling of sites within 150 miles of each state's capital was selected (n = 2073). Survey of 11 questions included availability of naltrexone for pregnant individuals, standard practices for treating pregnant individuals already on naltrexone, and barriers to treatment. Survey responses were summarized to identify top barriers and national trends in service availability. RESULTS Of the 236 sites contacted, 78 (33.1%) completed the survey. There was significant geographic variation in number of available sites, with Northeast United States having the most sites. Of the 78 responding sites, only 23 (35.9%) offered naltrexone for pregnant individuals. The most common barriers to prescribing naltrexone included the following: sites without pregnant patients (15.6%), lack of national guidelines in using naltrexone for pregnant patients (14.1%), providers' discomfort with prescribing naltrexone during pregnancy due to safety concerns (9.4%), and providers' discomfort due to inexperience (4.7%). CONCLUSIONS Accessibility of naltrexone and related care for pregnant individuals with alcohol use disorder and opioid use disorder varies greatly across the United States with numerous barriers and educational gaps identified. Additional research and resources are needed to expand naltrexone treatment access for pregnant individuals.
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Affiliation(s)
- Chloe Deflorimonte
- From the Department of Pediatrics, Boston Medical Center, Boston, MA (CD, NI, JOB, EMW); Boston University School of Public Health, Boston, MA (VG); Boston University Chobanian and Avedisian School of Medicine, Boston, MA (JH, AC); UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Carrboro, NC (GC, HEJ); and Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA (KAS)
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Guideline No. 443b: Opioid Use Throughout Women's Lifespan: Opioid Use in Pregnancy and Breastfeeding. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102144. [PMID: 37977721 DOI: 10.1016/j.jogc.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To provide health care providers the best evidence on opioid use and women's health. Areas of focus include pregnancy and postpartum care. TARGET POPULATION The target population includes all women currently using or contemplating using opioids. OUTCOMES Open, evidence-informed dialogue about opioid use will improve patient care. BENEFITS, HARMS, AND COSTS Exploring opioid use through a trauma-informed approach provides the health care provider and patient with an opportunity to build a strong, collaborative, and therapeutic alliance. This alliance empowers women to make informed choices about their own care. It also allows for the diagnosis and possible treatment of opioid use disorders. Opioid use should not be stigmatized, as stigma leads to poor "partnered care" (i.e., the partnership between the patient and care provider). Health care providers need to understand the effect opioids can have on pregnant women and support them to make knowledgeable decisions about their health. EVIDENCE A literature search was designed and carried out in PubMed and the Cochrane Library databases from August 2018 until March 2023 using following MeSH terms and keywords (and variants): opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome, and breastfeeding. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED AUDIENCE All health care providers who care for pregnant and/or post-partum women and their newborns. TWEETABLE ABSTRACT Opioid use during pregnancy often co-occurs with mental health issues and is associated with adverse maternal, fetal, and neonatal outcomes; treatment of opioid use disorder with agonist therapy for pregnant women can be safe during pregnancy where the risks outnumber the benefits. SUMMARY STATEMENTS RECOMMENDATIONS.
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Turner S, Allen VM, Carson G, Graves L, Tanguay R, Green CR, Cook JL. Directive clinique n o 443b : Opioïdes aux différentes étapes de la vie des femmes : Grossesse et allaitement. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:102146. [PMID: 37977719 DOI: 10.1016/j.jogc.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIF Présenter aux professionnels de la santé les données probantes concernant l'utilisation des opioïdes et la santé des femmes. Les domaines d'intérêt sont la grossesse et les soins post-partum. POPULATION CIBLE Toutes les femmes qui utilisent des opioïdes. RéSULTATS: Un dialogue ouvert et éclairé sur l'utilisation des opioïdes améliorera les soins aux patientes. BéNéFICES, RISQUES ET COûTS: L'exploration de l'utilisation d'opioïdes par une approche tenant compte des traumatismes antérieurs donne au professionnel de la santé et à la patiente l'occasion de bâtir une alliance solide, collaborative et thérapeutique. Cette alliance permet aux femmes de faire des choix éclairés. Elle favorise le diagnostic et le traitement possible du trouble lié à l'utilisation d'opioïdes. L'utilisation ne doit pas être stigmatisée, puisque la stigmatisation affaiblit le partenariat (le partenariat entre patiente et professionnel de la santé). Les professionnels de la santé ceus-ci doivent comprendre l'effet potentiel des opioïdes sur la santé les femmes enceintes et les aider à prendre des décisions éclairées sur leur santé. DONNéES PROBANTES: Une recherche a été conçue puis effectuée dans les bases de données PubMed et Cochrane Library pour la période d'août 2018 à mars 2023 des termes MeSH et mots clés suivants (et variantes) : opioids, opioid agonist therapy, illicit drugs, fertility, pregnancy, fetal development, neonatal abstinence syndrome et breastfeeding. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). PROFESSIONNELS CONCERNéS: Tous les professionnels de la santé qui prodiguent des soins aux femmes et aux nouveaux-nés. RéSUMé POUR TWITTER: La consommation d'opioïdes pendant la grossesse coïncide souvent avec des problèmes de santé mentale et est associée à des conséquences néfastes pour la mère, le fœtus et le nouveau-né ; le traitement des troubles liés à la consommation d'opioïdes par agonistes peut être sûr pendant la grossesse lorsque les risques sont plus nombreux que les avantages. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.
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O'Donoghue AL, Reichheld A, Anderson TS, Zera CA, Dechen T, Stevens JP. Decline in Prenatal Buprenorphine/Naloxone Fills during the COVID-19 Pandemic in the United States. J Addict Med 2023; 17:e399-e402. [PMID: 37934549 DOI: 10.1097/adm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVES Pregnancy provides a critical opportunity to engage individuals with opioid use disorder in care. However, before the COVID-19 pandemic, there were multiple barriers to accessing buprenorphine/naloxone during pregnancy. Care disruptions during the pandemic may have further exacerbated these existing barriers. To quantify these changes, we examined trends in the number of individuals filling buprenorphine/naloxone prescriptions during the COVID-19 pandemic. METHODS We estimated an interrupted time series model using linked national pharmacy claims and medical claims data from prepandemic (May 2019 to February 2020) to the pandemic period (April 2020 to December 2020). We estimated changes in the growth rate in the monthly number of individuals filling buprenorphine/naloxone prescriptions in the 6 months preceding a delivery claim, per 100,000 pregnancies, during the COVID-19 pandemic. RESULTS We identified 2947 pregnant individuals filling buprenorphine/naloxone prescriptions. Before the pandemic, there was positive growth in the monthly number of individuals filling buprenorphine/naloxone prescriptions (4.83%; 95% confidence interval [CI], 3.82-5.84%). During the pandemic, this monthly growth rate declined for both individuals on commercial insurance and individuals on Medicaid (all payers: -5.53% [95% CI, -6.65% to -4.41%]; Medicaid: -7.66% [95% CI, -10.14% to -5.18%]; Commercial: -3.59% [95% CI, -5.32% to -1.87%]). CONCLUSION The number of pregnant individuals filling buprenorphine/naloxone prescriptions was increasing, but this growth has been lost during the pandemic.
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Affiliation(s)
- Ashley L O'Donoghue
- From the Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA (ALO, AR, TSA, TD, JPS); Harvard Medical School, Boston, MA (ALO, TSA, CAZ, JPS); Tufts University School of Medicine, Boston, MA (AR); Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA (TSA); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (CAZ); and Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (JPS)
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Mazel S, Alexander K, Cioffi C, Terplan M. Interventions to Support Engagement in Addiction Care Postpartum: Principles and Pitfalls. Subst Abuse Rehabil 2023; 14:49-59. [PMID: 37424702 PMCID: PMC10327918 DOI: 10.2147/sar.s375652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023] Open
Abstract
There is a fundamental disconnect between the optimal management of addiction in general and care delivery in pregnancy and postpartum. Addiction is a chronic condition requiring some degree of management across the life course. Yet, in the US, reproductive care is episodic and centers more on pregnancy than at other stages of the reproductive life course. Pregnancy is prioritized in access to insurance as almost all pregnant people are Medicaid eligible but access ends at varying points postpartum. This results in a structural mismatch: the episodic management of the chronic condition of addiction only within gestational periods. Though people with substance use disorder (SUD) may access care in pregnancy, treatment attrition is common postpartum. Postpartum is a time of increased vulnerabilities where insurance churn and newborn caretaking responsibilities collide in a context of care withdrawal from the health system and health providers. In part in consequence, return to use, SUD recurrence, overdose, and overdose death are more common postpartum than in pregnancy, and drug deaths have become a leading cause of maternal deaths in the US. This review addresses interventions to support engagement in addiction care postpartum. We begin with a scoping review of model programs and evidence-informed interventions that have been shown to increase continuation of care postpartum. We then explore the realities of contemporary care through a review of clinical and ethical principles, with particular attention to harm reduction. We conclude with suggestions of strategies (clinical, research, and policy) to improve care postpartum and highlight potential pitfalls in the uptake of evidence-based and person-centered services.
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Affiliation(s)
- Shayna Mazel
- Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | | | - Camille Cioffi
- Center on Parenting and Opioids, Prevention Science Institute, University of Oregon, Eugene, OR, USA
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Peterkin AF, Baldwin M, Demers L, Gergen Barnett K. Evaluating a Video-Based Addiction Curriculum at a Safety Net Academic Medical Center. Subst Abus 2023; 44:241-248. [PMID: 37728099 DOI: 10.1177/08897077231195995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Since 2019, the United States (US) has witnessed an unprecedented increase in drug overdose and alcohol-related deaths. Despite this rise in morbidity and mortality, treatment rates for substance use disorder remain inadequate. Insufficient training in addiction along with a dearth of addiction providers are key barriers to addressing the current addiction epidemic. Addiction-related clinical experiences can improve trainee knowledge, yet they remain dependent on practice sites and residency training environments. Asynchronous learning, in the form of video-based modules, may serve as a complement to formal, scheduled lectures and clinical experiences. OBJECTIVES To evaluate the educational impact of a video-based addiction curriculum in 2 residency programs at a large safety net academic medical center with a high volume of patients with substance use disorders. METHODS Family Medicine (FM) and Internal Medicine (IM) residency interns (PGY1s) (n = 60) had access to 28 minutes of video content related to opioid use disorder (OUD) and alcohol use disorder (AUD) during the first 2 months of their residency training. Interns were asked to complete voluntary and anonymized pre- and post-surveys in Qualtrics that included knowledge and confidence-based questions about the management of OUD and AUD, in addition to questions about prior exposure to and future interests in addiction training and practice. Data were analyzed with non-parametric sign tests. RESULTS Twenty-eight interns completed both OUD pre- and post-surveys, and 24 interns completed all AUD survey questions. There was a statistically significant increase in the number of interns who reported increased knowledge of and confidence around diagnosis, management, and ability to provide evidence-based treatment recommendations for both OUD and AUD. CONCLUSIONS Brief addiction focused video-modules can improve confidence and knowledge in managing OUD and AUD among medical trainees.
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Affiliation(s)
- Alyssa F Peterkin
- Section of General Internal Medicine, Department of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Marielle Baldwin
- Department of Family Medicine, Grayken Center for Addiction, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lindsay Demers
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Katherine Gergen Barnett
- Department of Family Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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16
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Roley-Roberts ME, Edrees H, Thomas J, Weber S, Ramsey R, Walton J, Witwer A. Impact of an Asynchronous Training for the Early Intervention and Childcare Workforce Addressing the Developmental Impact of the Opioid Crisis on Young Children. Matern Child Health J 2023:10.1007/s10995-023-03679-4. [PMID: 37264219 DOI: 10.1007/s10995-023-03679-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES The US opioid epidemic contributes to a growing population of children experiencing neonatal abstinence syndrome (NAS) and adverse childhood experiences (ACEs). A review of the developmental impacts of the opioid crisis highlights that both prenatal exposure to teratogens and ACEs can result in developmental delay and disabilities. Training for the early intervention/early childhood (EI) systems is needed to enable them to meet the needs of this growing population. METHODS To address this, an IRB-approved online training on best practices for NAS, developmental monitoring and referral, and trauma-informed care was created for Ohio EI providers who provided informed consent to participate. The feasibility of utilizing an online training was assessed. Knowledge on opioid addiction, NAS, ACEs, and early intervention provider characteristics were collected for 2973 participants. RESULTS Within 6 months, the training reached providers in all Ohio counties and seventeen other states. 57% of providers reported caring for one or more children with a caregiver who has confirmed opioid use. 31% reported these children had experienced four or more ACEs. Providers' ACEs awareness was moderately associated with their experiences with prenatally-exposed youth. There was a significant increase in knowledge following training. Differences in post-training knowledge differed only by county-level opioid death rates, where those providers with low-medium opioid death rates reported more awareness of children with prenatal opioid exposure compared to participants who lived in a county with medium and medium-high opioid death rates. CONCLUSIONS Online-training is feasible for closing gaps in the early intervention system.
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Affiliation(s)
- Michelle E Roley-Roberts
- Nisonger Center LEND Program, Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
- Department of Psychiatry, Creighton University, 7101 Newport Avenue, Suite 203, Omaha, NE, 68152, USA.
| | - Hanein Edrees
- Cincinnati LEND Program, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessy Thomas
- Nisonger Center LEND Program, Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Steph Weber
- Cincinnati LEND Program, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Riane Ramsey
- Nisonger Center LEND Program, Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jennifer Walton
- Nisonger Center LEND Program, Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Andrea Witwer
- Nisonger Center LEND Program, Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Vella A, Savona-Ventura C, Mahmood T. Harmful effects of opioid use in pregnancy: A scientific review commissioned by the European Board and College of obstetrics and gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2023; 286:70-75. [PMID: 37216740 DOI: 10.1016/j.ejogrb.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Caring for pregnant women who have a recreational opioid use disorder is a common clinical challenge in modern obstetric care. These are an elusive population who often have multiple social issues that complicate their pregnancy management. Comprehensive and supportive maternal care can motivate these mothers to change her lifestyle. Multidisciplinary non-judgemental approach with appropriate medication and management, can result in good pregnancy outcomes for mother and her baby.
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Affiliation(s)
| | - Charles Savona-Ventura
- Department of Obstetrics and Gynaecology, University of Malta, Member EBCOG Standing Committee on Standards of Care and Position Statements, Malta; Member of the EBCOG Standing Committee on Standards of Care and Position Statements, Malta
| | - Tahir Mahmood
- Victoria Hospital, Kirkcaldy and Spire Murrayfield Hospital, Edinburgh, United Kingdom; Member of the EBCOG Standing Committee on Standards of Care and Position Statements, Malta
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18
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Wanar A, Morrison T, Standish K, Colson ER, Drainoni ML, Colvin BN, Safon CB, Crowell L, Friedman H, Schiff D, Parker MG. Understanding cigarette smoking among mothers with opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 150:209065. [PMID: 37156425 DOI: 10.1016/j.josat.2023.209065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/17/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Cigarette smoking is highly prevalent among mothers with opioid use disorder (OUD). Organizations such as the American College of Obstetrics and Gynecology recommend cessation of cigarettes during the pre- and postnatal periods. Factors that inform decisions to continue or stop smoking cigarettes among pregnant and postpartum mothers with OUD are unclear. AIMS This study aimed to understand (1) the lived experience of mothers with OUD regarding cigarette smoking and (2) barriers and facilitators to reduction of cigarette smoking during the pre- and postnatal periods. METHODS Guided by the Theory of Planned Behavior (TPB) framework, we completed semi-structured, in-depth interviews with mothers with OUD with infants 2-7 months of age. We used an iterative approach to analysis by conducting interviews and developing and revising codes and themes until we reached thematic saturation. RESULTS Fifteen of 23 mothers reported smoking cigarettes prenatally and postnatally, 6 of 23 smoked cigarettes during the prenatal period only, and 2 mothers were non-smokers. We found that mothers: 1) believed that smoke exposure had negative health consequences and may exacerbate withdrawal symptoms for their infants; 2) implemented risk mitigation practices, which were dictated both by themselves and by outside rules, to reduce the harmful effects of smoke around infants; 3) were motivated to quit or cut-down on smoking because of the desire to optimize the health and well-being of their infants; 4) continued to smoke because they felt that the stress related to caregiving and their own recovery were a higher priority than quitting smoking; and 5) were influenced by exposure to smokers with whom they lived, as well as by the varied advice of medical providers, family, and friends. CONCLUSION While mothers with OUD acknowledged the negative health impact of cigarette smoke exposure to their infants, many experienced stressors related to recovery and caregiving unique to those with OUD that impacted their cigarette smoking behaviors.
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Affiliation(s)
- Amita Wanar
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA, United States of America
| | - Tierney Morrison
- Department of Newborn Medicine, Boston Children's Hospital, Boston, MA, United States of America
| | - Katherine Standish
- Department of Family Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America
| | - Eve R Colson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston University School of Medicine, United States of America; Department of Health Law, Policy & Management, Boston University School of Public Health, United States of America
| | - Bryanne N Colvin
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Cara B Safon
- Department of Health Law, Policy & Management, Boston University School of Public Health, United States of America
| | - Lisa Crowell
- Slone Epidemiology Center, Boston University, United States of America
| | - Hayley Friedman
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Davida Schiff
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, United States of America
| | - Margaret G Parker
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States of America.
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Xu KY, Jones HE, Schiff DM, Martin CE, Kelly JC, Carter EB, Bierut LJ, Grucza RA. Initiation and Treatment Discontinuation of Medications for Opioid Use Disorder in Pregnant People Compared With Nonpregnant People. Obstet Gynecol 2023; 141:845-853. [PMID: 36897142 PMCID: PMC10201921 DOI: 10.1097/aog.0000000000005117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/12/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To examine the association between pregnancy and medications for opioid use disorder (MOUD) initiation and discontinuation among reproductive-aged people receiving treatment for opioid use disorder (OUD) in the United States. METHODS We conducted a retrospective cohort study of people with gender recorded as female, aged 18-45 years, in the Merative TM MarketScan ® Commercial and Multi-State Medicaid Databases (2006-2016). Opioid use disorder and pregnancy status were identified based on inpatient or outpatient claims for established International Classification of Diseases, Ninth and Tenth Revision diagnosis and procedure codes. The main outcomes were buprenorphine and methadone initiation and discontinuation, determined by using pharmacy and outpatient procedure claims. Analyses were conducted at the treatment episode level. Adjusting for insurance status, age, and co-occurring psychiatric and substance use disorders, we used logistic regression to estimate MOUD initiation and used Cox regression to estimate MOUD discontinuation. RESULTS Our sample included 101,772 reproductive-aged people with OUD, encompassing 155,771 treatment episodes (mean age 30.8 years, 64.4% Medicaid insurance, 84.1% White), of whom 2,687 (3.2%, encompassing 3,325 episodes) were pregnant. In the pregnant group, 51.2% of treatment episodes (1,703/3,325) involved psychosocial treatment without MOUD, in comparison with 61.1% (93,156/152,446) in the nonpregnant comparator group. In adjusted analyses assessing likelihood of initiation for individual MOUD, pregnancy status was associated with an increase in buprenorphine (adjusted odds ratio [aOR] 1.57, 95% CI 1.44-1.70) and methadone initiation (aOR 2.04, 95% CI 1.82-2.27). Discontinuation rates of MOUD at 270 days were high for both buprenorphine (72.4% for nonpregnant episodes vs 59.9% for pregnant episodes) and methadone (65.7% for nonpregnant episodes vs 54.1% for pregnant episodes). Pregnancy was associated with a decreased likelihood of discontinuation at 270 days for both buprenorphine (adjusted hazard ratio [aHR] 0.71, 95% CI 0.67-0.76) and methadone (aHR 0.68, 95% CI 0.61-0.75), in comparison with nonpregnant status. CONCLUSION Although a minority of reproductive-aged people with OUD in the United States are initiated on MOUD, pregnancy is associated with a significant increase in treatment initiation and a reduced risk of medication discontinuation.
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Affiliation(s)
- Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Davida M Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA, USA
| | - Caitlin E Martin
- Department of Obstetrics and Gynecology and VCU Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Jeannie C Kelly
- Division of Maternal-Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ebony B Carter
- Division of Maternal-Fetal Medicine and the Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Laura J Bierut
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J Siteman Cancer Center, Barnes Jewish Hospital, St. Louis, MO, USA
| | - Richard A Grucza
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, St. Louis, MO, USA
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20
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Bremer MJ, Knippen KL. Breastfeeding Experiences in Women from Ten States Reporting Opioid Use Before or During Pregnancy: PRAMS, Phase 8. Matern Child Health J 2023; 27:747-756. [PMID: 35947276 DOI: 10.1007/s10995-022-03497-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION Evidence of opioid use at hospital delivery has increased over the past two decades, increasing risk of neonatal withdrawal. Breastfeeding may improve infant outcomes, but little is known about breastfeeding experiences of women who have a history of opioid use prior to or during pregnancy. This study aimed to determine if self-reported opioid use prior to or during pregnancy impacted breastfeeding, specifically attempt to breastfeed, duration of breastfeeding, assessment of prenatal breastfeeding intention, source of breastfeeding information, and early hospital experiences. METHODS Data from ten states (n = 10,550) that evaluated opioid use in the 2016 Pregnancy Risk Assessment Monitoring System survey were included. Weighted univariate and multivariate linear and logistic regression were calculated. The multivariate regression also included adjustment for covariates. RESULTS Among the overall sample, 939 participants reported opioid exposure before or during pregnancy. We found no significant difference in breastfeeding attempt. Breastfeeding for at least 6, 10, or 20 weeks was significantly less likely in participants reporting opioid exposure. Exposure correlated with lower odds of skin-to-skin contact, infant being fed in the first hour, exclusive breastfeeding in the hospital, and feeding on demand. Hospital pacifier use was associated with opioid exposure. CONCLUSION While we found no difference in breastfeeding attempt, we did observe significant differences in breastfeeding duration and early hospital experiences which may represent modifiable gaps in clinical practice. Future work should focus on optimizing early hospital experiences and support when breastfeeding is clinically indicated.
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Affiliation(s)
- Madeleine Jade Bremer
- Food Service Director and Community Nutrition Educator, Camp Beechpoint 3212 125th Ave, Allegan, Michigan, USA
| | - Kerri Lynn Knippen
- Department of Public & Allied Health, Bowling Green State University, 122 Health & Human Services Building, Bowling Green, OH, USA.
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Steely Smith MK, Wilson SH, Zielinski MJ. An integrative literature review of substance use treatment service need and provision to pregnant and postpartum populations in carceral settings. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057221147802. [PMID: 36920150 PMCID: PMC10021089 DOI: 10.1177/17455057221147802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/12/2022] [Accepted: 12/08/2022] [Indexed: 03/16/2023]
Abstract
Pregnancy is a critical time to provide access to substance use treatment; this is especially true among incarcerated populations, who are known to be at particularly high risk of poor health outcomes. In this integrated literature review, we (1) report what is known about the prevalence of substance use among incarcerated pregnant and postpartum populations; (2) describe substance use treatment programs and current care practices of pregnant and postpartum populations in carceral settings; and (3) explore recommendations and strategies for increasing access to substance use treatment for incarcerated pregnant and postpartum populations. A comprehensive search of seven electronic databases yielded in the retrieval of 139 articles that were assessed for inclusion. Of the retrieved articles, 33 articles met criteria for inclusion in this review. A review of the literature revealed that the understanding of substance use prevalence among pregnant incarcerated women is limited. We also found that treatment of substance use disorders among pregnant and postpartum populations is not routinely available, enhanced perinatal services are sorely needed, and substance use treatment programs are feasible with the help of community partnerships. More research is required to understand current substance use treatment initiatives and outcomes for pregnant women in prison. In addition, strategies for integrating evidence-based, substance use treatment in carceral settings is also needed. Future directions are discussed.
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Affiliation(s)
| | | | - Melissa J Zielinski
- University of Arkansas for Medical
Sciences, Little Rock, AR, USA
- University of Arkansas, Fayetteville,
AR, USA
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22
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Worth T. Caring for people and their babies in the opioid crisis. Nature 2022; 612:S56-S58. [PMID: 36536217 DOI: 10.1038/d41586-022-04347-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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Burduli E, Winquist A, Smith CL, Brooks O, Chiou M, Balsiger D, Shogan M, McPherson SM, Barbosa-Leiker C, Jones HE. Supporting perinatal individuals with opioid use disorder and their newborns experiencing neonatal abstinence syndrome: impressions from patients and healthcare providers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:596-605. [PMID: 36166744 PMCID: PMC9645816 DOI: 10.1080/00952990.2022.2122483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Facilitating maternal-newborn involvement and care is critical for improving outcomes for perinatal individuals receiving opioid agonist therapy (OAT) and newborns experiencing Neonatal Abstinence Syndrome (NAS). Comprehensive education strategies are needed to prepare pregnant individuals receiving OAT for navigating the perinatal period.Objectives: Identify facilitators to successful care of perinatal individuals receiving OAT and newborns experiencing NAS via interviews with perinatal individuals and healthcare providers. The goal of identifying this information is to inform a future educational tool development.Methods: Ten perinatal individuals receiving OAT and ten healthcare providers participated in interviews conducted via phone or video conference using semi-structured, open-ended questions. Data were analyzed separately for the two groups and later merged across samples using a qualitative descriptive content analysis approach to identify themes.Results: Under the overarching theme of empowerment to improve outcomes for perinatal women, four themes arose from perinatal and provider interviews: 1) Preparation for Child Protective Services (CPS) involvement, 2) Healthcare providers shape experience through stigma and support 3) Caring for newborns with NAS, and 4) Managing health and resources during postpartum.Conclusion: Perinatal participants emphasized the importance of self-advocacy while navigating healthcare and social systems. Providers highlighted the importance of communicating expectations to empower patients. Education is needed for pregnant individuals receiving OAT on what to expect during pregnancy and postpartum, as well as for providers to help them optimally support their perinatal patients receiving OAT.
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Affiliation(s)
- Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, USA,Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Anna Winquist
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Crystal Lederhos Smith
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Michelle Chiou
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Danica Balsiger
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Maureen Shogan
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Sterling M. McPherson
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, UNC Horizons, University of North Carolina, Chapel Hill, NC, USA
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24
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Khan AR, Olatunji O, Qureshi D, Metellus P, Nkemjika S. Accessibility of Treatment Among Women With Opioid Use Disorder: A Brief Review. Cureus 2022; 14:e27509. [PMID: 36060319 PMCID: PMC9426717 DOI: 10.7759/cureus.27509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2022] [Indexed: 12/05/2022] Open
Abstract
Opioid-use disorder (OUD) has become a social pandemic with a rising incidence and prevalence among women. Notably, women with OUD were more likely to have psychiatric comorbidities like major depressive disorder, anxiety disorder, and bipolar disorder. Evidence suggests that opioid exposure and subsequent disease among women compared to men is unique and attributable to hormonal estrogen levels. However, there remains a dearth of literature on their ability to access treatment when needed. There is also a gap in the perceived access to women as compared to men. Hence, our review will focus on factors that may affect women from seeking OUD treatment as compared to men.
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Guille C, Hall C, King C, Sujan A, Brady K, Newman R. Listening to women and pregnant and postpartum people: Qualitative research to inform opioid use disorder treatment for pregnant and postpartum people. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 3:100064. [PMID: 36845990 PMCID: PMC9948937 DOI: 10.1016/j.dadr.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/13/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022]
Abstract
Background The diagnosis of Opioid Use Disorder (OUD) during pregnancy has increased 2-to-5-fold over the past decade and barriers to treatment are significant. Technology-based solutions have the potential to overcome these barriers and deliver evidence-based treatment. However, these interventions need to be informed by end-users. The goal of this study is to gain feedback from peripartum people with OUD and obstetric providers about a web-based OUD treatment program. Methods Qualitative interviews were conducted with peripartum people with OUD (n = 18) and focus groups were conducted with obstetric providers (n = 19). Feedback from these interviews informed the development of text message-based screening, brief phone-based intervention and referral to treatment program, called Listening to Women and Pregnant and Postpartum People (LTWP). Once developed, further qualitative interviews with peripartum people with OUD (n = 12) and obstetric providers (n = 21) were conducted to gather feedback about the LTWP program. Results Patients reported that a relationship with a trusted provider is paramount for treatment engagement. Providers reported that time constraints and complex patient needs prohibit them from treating OUD and that evidence-based Screening, Brief Intervention and Referral to Treatment (SBIRT) are not implemented effectively in routine prenatal care. Neither patients nor providers were enthusiastic about our web-based intervention for OUD; thus, results were used to guide the development of LTWP to improve implementation of SBIRT during prenatal care. Conclusions End-user informed, technology-enhanced SBIRT has the potential to improve the implementation of SBIRT during routine prenatal care, and in turn, improve maternal and child health.
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Affiliation(s)
- Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Casey Hall
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
| | - Courtney King
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
| | - Ayesha Sujan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Kathleen Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, 5 South, MSC861, Charleston, SC 29425, USA
- Department of Psychological and Brain Sciences, Indiana University – Bloomington, Bloomington, IN, USA
| | - Roger Newman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
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26
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Incarceration exposure and prescription opioid use during pregnancy. Drug Alcohol Depend 2022; 235:109434. [PMID: 35405460 DOI: 10.1016/j.drugalcdep.2022.109434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prior research demonstrates a high prevalence of substance use, including opioid use, among those who have had personal or vicarious contact with the correctional system. Relatedly, alongside patterns of rising opioid use in general, opioid use during pregnancy is becoming a growing public health concern. Still, risk factors for prescription opioid use during pregnancy remain understudied. This study is the first to assess the connection between a women's personal or vicarious exposure to incarceration in the 12 months prior to birth and patterns of prenatal opioid use. METHODS Data are from the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2019 (N = 17,551 mothers). Logistic and multinomial logistic regression are used to assess the association between incarceration exposure and patterns of opioid use during pregnancy. RESULTS Incarceration-exposed women were more likely to use all eight types of prescription opioids assessed in this study (Hydrocodone, Codeine, Oxycodone, Tramadol, Hydromorphone/Meperidine, Oxymorphone, Morphine, and Fentanyl). After adjustment for control variables, incarceration-exposed women were significantly more likely to report any prescription opioid use during pregnancy (OR = 1.745, 95% CI = 1.194, 2.554). Furthermore, relative to no opioid use, incarceration exposure was also associated with illicit prescription opioid use (RRR = 2.979, 1.533, 5.791). CONCLUSIONS Incarceration exposure in the year prior to birth is associated with higher odds of prescription opioid use. These findings add to the burgeoning literature that details a women's exposure to incarceration is a risk marker for substance use and engagement in health risk behaviors that can jeopardize maternal and infant wellbeing.
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Nichols TR, Gringle MR, Welborn A, Lee A. “We Have to Keep Advocating and Helping and Doing What We Can”: Examining Perinatal Substance Use Services in the Absence of Integrated Treatment Programs. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426221092771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effective treatment of substance-exposed pregnancies requires gender-responsive care coordinated across agencies and systems. A deeper understanding of the perspectives, experience, and practices of professionals providing these services is needed to improve care. This study examines service provision for perinatal substance use through the perspectives and experiences of healthcare and social service professionals. Using a constructivist grounded theory design, data were collected over a 7-year period. Data collection consisted of interviews and focus groups with professionals as well as observations of professional meetings and workshops where practices and procedures were discussed. A multi-level model of service delivery is described. The role of affect, particularly around issues of custody, is discussed along with structural level actions that develop in the absence of integrated treatment. Structural support both within and across systems of care is crucial to developing coordinated and compassionate care and to increasing engagement in care services.
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Affiliation(s)
| | | | - Amber Welborn
- Beaver College of Health Science, Appalachian State University, Boone, NC, USA
| | - Amy Lee
- University of North Carolina Greensboro, Greensboro, NC, USA
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28
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Pemathilaka RL, Alimoradi N, Reynolds DE, Hashemi NN. Transport of Maternally Administered Pharmaceutical Agents Across the Placental Barrier In Vitro. ACS APPLIED BIO MATERIALS 2022; 5:2273-2284. [PMID: 35380796 PMCID: PMC9116385 DOI: 10.1021/acsabm.2c00121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To understand the transport of pharmaceutical agents and their effects on developing fetus, we have created a placental microsystem that mimics structural phenotypes and physiological characteristic of a placental barrier. We have shown the formation of a continuous network of epithelial adherens junctions and endothelial cell-cell junctions confirming the integrity of the placental barrier. More importantly, the formation of elongated microvilli under dynamic flow condition is demonstrated. Fluid shear stress acts as a mechanical cue triggering the microvilli formation. Pharmaceutical agents were administered to the maternal channel, and the concentration of pharmaceutical agents in fetal channel for coculture and control models were evaluated. In fetal channel, the coculture model exhibited about 2.5 and 2.2% of the maternal initial concentration for naltrexone and 6β-naltrexol, respectively. In acellular model, fetal channel showed about 10.5 and 10.3% of the maternal initial concentration for naltrexone and 6β-naltrexol, respectively. Gene expressions of epithelial cells after direct administration of naltrexone and 6β-naltrexol to the maternal channel and endothelial cells after exposure due to transport through placental barrier are also reported.
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Affiliation(s)
- Rajeendra L Pemathilaka
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, United States
| | - Nima Alimoradi
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, United States
| | - David E Reynolds
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, United States
| | - Nicole N Hashemi
- Department of Mechanical Engineering, Iowa State University, Ames, Iowa 50011, United States.,Department of Mechanical Engineering, Stanford University, Stanford, California 94305, United States
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29
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Abstract
Opioid Use Disorder Diagnosis and ManagementThe last 20 years have seen a staggering increase in opioid-related morbidity and mortality. Although the consequences of untreated OUDs are significant, OUD is a treatable illness. This article reviews the epidemiology of OUD and its complications, screening, diagnosis, treatment, and harm reduction interventions.
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Affiliation(s)
- Sarah E Wakeman
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Department of Medicine, Harvard Medical School, Boston
- Department of Quality, Patient Experience, and Equity, Mass General Brigham, Boston
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30
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Leiner C, Antono B, Ostrach B. Perinatal OUD Treatment Provider Understandings of Rural Patients' Experiences. J Addict Med 2022; 16:177-182. [PMID: 35289773 DOI: 10.1097/adm.0000000000000858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To present perspectives of substance use treatment providers offering perinatal opioid use disorder (OUD) treatment in a largely rural, Appalachian region. To demonstrate the extent to which providers sought to understand their patients' experiences accessing treatment and how this understanding informed providers' approach to offering patient-centered care. METHODS A qualitative study combining semi-structured interviews and participant-observation with perinatal substance use treatment providers, conducted within a comprehensive program. Using purposive and opportunistic sampling with key informants (n = 10), a saturation sample was achieved. Data were analyzed using modified Grounded Theory. RESULTS Perinatal substance use treatment providers had a good understanding of their patients' experiences seeking treatment for opioid use disorder, including being aware of obstacles patients encountered. This understanding allowed providers to better address patients' needs in and out of the clinic. CONCLUSIONS Participants demonstrated a good understanding of what their largely rural, Appalachian patients experienced when attempting to access perinatal OUD treatment. This understanding may enable more patient-centered care.
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Affiliation(s)
- Catherine Leiner
- UNC Health Sciences at MAHEC, Asheville, NC (CL); Family Medicine Residency Program, Mountain Area Health Education Center, Asheville, NC (BA); Medical resident in a program partially supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $1,656,886 with 0 percent financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. (This statement is required by HRSA to be included in all publications on which a HRSA-funded medical resident is listed as an author.) (BA); Department of Research, UNC Health Sciences at MAHEC, Asheville, NC (BO); Boston University School of Medicine, Boston, MA (BO)
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31
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Shadowen C, Jallo N, Parlier-Ahmad AB, Brown L, Kinser P, Svikis D, Martin CE. What Recovery Means to Postpartum Women in Treatment for Opioid Use Disorder. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2022; 3:93-103. [PMID: 35136881 PMCID: PMC8812494 DOI: 10.1089/whr.2021.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 11/12/2022]
Abstract
Introduction: Opioid overdose has become a leading cause of pregnancy-associated deaths, particularly in the 1st year postpartum, highlighting the need to better understand how to promote recovery for postpartum women. This mixed-methods study aims to investigate how postpartum women receiving medication for opioid use disorder (MOUD) define recovery and factors associated with recovery progression or inhibition. Methods: Women receiving MOUD 2-6 months postpartum were recruited from an outpatient perinatal addiction clinic. Participants completed electronic measures including the Brief Assessment of Recovery Capital (BARC-10, total score range: 6-60) and semistructured individual interviews. Substance Abuse and Mental Health Services Administration (SAMHSA)'s recovery framework served as the conceptual model for interview guide development. Descriptive statistics were generated for survey responses. A qualitative descriptive approach was used to analyze and report the interview data. Results: On average, participants (n = 8) were 28.6 years old and taking 19.5 mg/day buprenorphine (range 8-24). Fifty percent identified as white and 37.5% as black. All participants identified as currently in recovery, with mean BARC-10 score 52.5 (standard deviation 4.8). Recovery goals included no use of drugs or alcohol (62.5%), being a better partner/spouse (87.5%), and improving finances (87.5%). Interviews generated themes including recovery as transformative, building resilience, and transforming one's health, relationships, and environment through recovery. Conclusions: Participants defined recovery as a dynamic transformative process, including nonabstinence-based goals consistent with SAMHSA domains coupled with reduced substance use. Central to recovery for our postpartum participants was the sense of self reinforced throughout their recovery journey. Women highlighted the key role of MOUD in their recovery process. Findings underscore the need for individualized treatment for postpartum women with opioid use disorder based on their personal goals and will inform development of a validated, gender-informed measure of patient-reported recovery outcomes tailored for this population.
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Affiliation(s)
- Caroline Shadowen
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nancy Jallo
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anna Beth Parlier-Ahmad
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lisa Brown
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Patricia Kinser
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dace Svikis
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, Institute for Women's Health, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caitlin E Martin
- Virginia Commonwealth University Health System, Richmond, Virginia, USA.,Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Family and Community Health Nursing, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.,Institute for Drug and Alcohol Studies, Virginia Commonwealth University, Richmond, Virginia, USA
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32
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What Obstetrician–Gynecologists Should Know About Substance Use Disorders in the Perinatal Period. Obstet Gynecol 2022; 139:317-337. [DOI: 10.1097/aog.0000000000004657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
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Bello JK, Salas J, Grucza R. Preconception health service provision among women with and without substance use disorders. Drug Alcohol Depend 2022; 230:109194. [PMID: 34871977 DOI: 10.1016/j.drugalcdep.2021.109194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Drug and alcohol use during pregnancy is associated with significant adverse birth outcomes and maternal morbidity. Addressing health and risky behaviors before pregnancy, in the preconception period, can improve both maternal and infant outcomes. However, the prevalence of preconception service delivery among women with substance use disorders (SUD) is unknown. METHODS Using Optum®, a de-identified Electronic Health Record dataset containing data from 5 million nationally distributed US adults from 2010 to 2018, we conducted a cross-sectional analysis of 18-55-year-old women with delivery between 2012 and 2018 (n = 52,565). Preconception services received in the year before pregnancy were identified using ICD-9/10 V and Z codes. Logistic regression was used to assess the relationship of any SUD vs. no SUD and preconception services received before and after adjusting for confounding. RESULTS Average age was 29.3 ( ± 5.0 years); 6.4% (n = 3371) of the sample had a diagnosis of any SUD and 6.0% (n = 3144) received any preconception services in the year before pregnancy. Women with SUD vs. without had higher prevalence of receiving any preconception services (9.6% versus 5.7%, p < 0.001). Compared to women without SUD, women with SUD had increased odds of receiving preconception services adjusting for medical comorbidities (OR=1.39; 95% CI=1.22-1.58) that was no longer significant when psychiatric comorbidities were added (OR=1.11; 95% CI=0.97-1.27). CONCLUSIONS There are numerous missed opportunities to provide preconception services to women with and without SUD. While delivering preconception services, healthcare providers have an opportunity to screen for SUD which may be more prevalent among women with psychiatric and medical problems.
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Affiliation(s)
- Jennifer K Bello
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, United States.
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, United States.
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, SLUCare Academic Pavilion, 1008S. Spring Ave. 3rd Floor, Saint Louis, MO 63110, United States.
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Medication for Addiction Treatment and Postpartum Health Care Utilization Among Pregnant Persons With Opioid Use Disorder. J Addict Med 2022; 16:56-64. [PMID: 33675606 PMCID: PMC8417138 DOI: 10.1097/adm.0000000000000827] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To estimate treatment and postpartum health care utilization among pregnant persons with opioid use disorder (OUD) in Vermont and Maine. METHODS Vermont's and Maine's All Payer Claims Databases were used to identify deliveries 2010 to 2018 that were paid for, in part, by Medicaid. OUD was identified among pregnant persons if they had any claim with an OUD-diagnosis code (ICD-9/10) or medication for addiction treatment (MAT) code during the 5 months before delivery event. Consistent and inconsistent MAT were compared to no MAT on the rate of hospitalizations and emergency department (ED) visits in the first 12 months' postpartum using negative binomial regression. RESULTS From 2010 through 2018, 27,652 deliveries in Vermont and 43,480 deliveries in Maine were among persons insured by Medicaid. The prevalence of OUD among pregnant persons increased from 6.7% to 11.6% in Vermont and from 7.4% to 11.0% in Maine. Among pregnant persons with OUD in 2018, 57% had consistent MAT in Vermont and 50% had consistent MAT in Maine; approximately 32% and 27% were not in treatment in Vermont and Maine, respectively. In Maine, consistent MAT was associated with a 47% lower rate of hospitalization and 37% to 46% lower rates of ED visits when compared to those without MAT; in Vermont, those with consistent buprenorphine treatment had a 30% lower rate of ED visits. CONCLUSIONS Medicaid data from Vermont and Maine suggests that medication for addiction treatment for opioid use disorder during pregnancy reduces emergency health care utilization in the first year postpartum.
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35
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Woods LM, Connelly CD. Opioid Use Treatment and Recovery Services During Pregnancy. J Am Psychiatr Nurses Assoc 2022; 28:58-67. [PMID: 34308696 DOI: 10.1177/10783903211033033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The maternal and neonatal consequences of not receiving treatment for opioid use disorders (OUDs) is well known. To prevent adverse outcomes and provide appropriate treatment and services, it is imperative to understand factors influencing pregnant women with OUDs to seek treatment. OBJECTIVES The purpose of this study is to identify barriers and facilitators related to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids. METHOD Retrospective analysis of data from the National Survey on Drug Use and Health (NSDUH), using 2016, 2017, and 2018 NSDUH data. Sample included 122 pregnant and 3,305 nonpregnant women who misused opioids. RESULTS Significant associations were noted among women who misused opioids (n = 3,427); age (χ2 = 25.406, p < .001), race/ethnicity (likelihood ratio [LR] = 17.721, p < .007), geographic location (χ2 = 7.585, p < .023), health insurance (LR = 13.909, p < .016), tobacco use within the past year (χ2 = 7.058, p = .008), and alcohol use within the past month (χ2 = 76.783, p < 0.001), 3.3% pregnant and 1.8% nonpregnant women who misuse opioids perceive a need to obtain treatment; 10.7% pregnant and 6.5% nonpregnant women currently receiving treatment for opioid misuse. The Strengthening the Reporting of Observational studies in Epidemiology checklist was used to develop the study. CONCLUSIONS It is our responsibility to equally focus efforts on understanding the construct of perceived need and help seeking behaviors among pregnant women, as well as, deploy known techniques to engage them in recovery. Further research is necessary to explore the construct of perceived need in this population, as well as, strategies to increase engagement.
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Affiliation(s)
- Loralie M Woods
- Loralie M. Woods, PhD RNBC, Sharp Mesa Vista Hospital, San Diego, CA, USA
| | - Cynthia D Connelly
- Cynthia D. Connelly PhD, RN, FAAN, University of San Diego, San Diego, CA, USA
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36
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Attanasio LB, DaCosta M, Kleppel R, Govantes T, Sankey HZ, Goff SL. Community Perspectives on the Creation of a Hospital-Based Doula Program. Health Equity 2021; 5:545-553. [PMID: 34909521 PMCID: PMC8665817 DOI: 10.1089/heq.2020.0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: Racial and ethnic inequities in perinatal health outcomes are pervasive. Doula support is an evidence-based practice for improving maternal outcomes. However, women in lower-income populations often do not have access to doulas. This study explored community perspectives on doula care to inform the development of a hospital-based doula program to serve primarily low-income women of color. Methods: Four focus groups and four individual interviews were conducted with: (1) women who were pregnant or parenting a child under age 2 (n=20); (2) people who had provided support during a birth in the previous 2 years (n=5); and (3) women who had received doula training (n=4). Results: Participants had generally positive perceptions of doula services. Many aspects of doula support desired by participants are core to birth doula services. Participants identified ways that doulas could potentially address critical gaps in health care services known to impact outcomes (e.g., continuity of care and advocacy), and provide much-needed support in the postpartum period. Responses also suggested that doula training and hospital-based doula programs may need to be adapted to address population-specific needs (e.g., women with substance use disorder and younger mothers). Novel program suggestions included “on call” informational doulas. Conclusions: Findings suggested that women in racial/ethnic minority and lower income groups may be likely to utilize a hospital-based doula program and identified adaptations to traditional doula care that may be required to best meet the needs of women in groups with higher risk of poor maternal health and birth outcomes.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Marisa DaCosta
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Reva Kleppel
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Tiki Govantes
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Heather Z Sankey
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
| | - Sarah L Goff
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, Massachusetts, USA
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Doerzbacher M, Sperlich M, Hequembourg A, Chang YP. Scoping Review of Barriers and Facilitators of Breastfeeding in Women on Opioid Maintenance Therapy. J Obstet Gynecol Neonatal Nurs 2021; 51:29-40. [PMID: 34655544 DOI: 10.1016/j.jogn.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To synthesize the literature on the barriers and facilitators of breastfeeding among women on opioid maintenance therapy (OMT) to inform nursing interventions and improve breastfeeding outcomes. DATA SOURCES We searched 11 databases using the following key terms: breastfeeding, barriers, facilitators, promotion, and opioid. STUDY SELECTION We included articles published in English since 2015 that addressed barriers and facilitators of breastfeeding in women on OMT. We did not limit our search to specific types of studies. Our search produced 65 records. After reviewing titles and abstracts, we assessed 21 full-text articles and excluded seven for lack of data related to our key terms. As a result, we included five qualitative studies, three reviews, three mixed-methods studies, two retrospective cohort studies, and one case report (14 articles) in our final review. DATA EXTRACTION We extracted data from each article and sorted them in a table for analysis and synthesis. Data included study purpose, research questions, design and methodology, and findings specifically pertaining to the identification of barriers and facilitators of breastfeeding for women on OMT. DATA SYNTHESIS We identified three themes related to facilitators of and barriers to breastfeeding: Information, Support, and Health Care System Factors. CONCLUSION The results of our review suggest that most barriers and facilitators of breastfeeding in women on OMT are manageable with improved health care practices. Primary and acute care health professionals should modify practices to minimize barriers to breastfeeding. Nurses should provide better breastfeeding education and preparation, sensitive care in the immediate postpartum period, and extended follow-up after hospital discharge for women on OMT.
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Schuetze P, Godleski S, Sassaman J. Prenatal exposure to opioids: Associations between the caregiving environment and externalizing behaviors. Neurotoxicol Teratol 2021; 87:107019. [PMID: 34403741 DOI: 10.1016/j.ntt.2021.107019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/15/2022]
Abstract
Maternal opioid use during pregnancy is a rapidly growing public health crisis and is associated with a range of adverse developmental outcomes including externalizing behaviors among exposed children. Recent work has highlighted the role of indirect pathways from prenatal opioid exposure to behavioral outcomes through aspects of the caregiving environment, including parenting. This review highlights maternal sensitivity and related aspects of the caregiving environment that may impact the development of externalizing behaviors among children with a history of prenatal exposure to opioids. We conclude by providing suggestions for future directions in research examining development among children with prenatal opioid exposure.
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Affiliation(s)
- Pamela Schuetze
- Department of Psychology, Buffalo State College, The State University of New York, USA; The Pennsylvania State University, USA.
| | | | - Jenna Sassaman
- Department of Psychology, College of Liberal Arts, The Pennsylvania State University, USA
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Labella MH, Eiden RD, Roben CKP, Dozier M. Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up. Front Psychol 2021; 12:675866. [PMID: 34489793 PMCID: PMC8418066 DOI: 10.3389/fpsyg.2021.675866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/13/2021] [Indexed: 01/10/2023] Open
Abstract
Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.
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Affiliation(s)
- Madelyn H. Labella
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Rina D. Eiden
- Department of Psychology, Pennsylvania State University, University Park, PA, United States
| | - Caroline K. P. Roben
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Peacock-Chambers E, Schiff DM, Zuckerman B. Caring for Families with Young Children Affected by Substance Use Disorder: Needed Changes. J Dev Behav Pediatr 2021; 42:408-410. [PMID: 33883526 PMCID: PMC8192421 DOI: 10.1097/dbp.0000000000000942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Elizabeth Peacock-Chambers
- Department of Pediatrics, University of Massachusetts Medical School-Baystate
- Institute for Healthcare Delivery and Population Science, Springfield, MA
| | - Davida M. Schiff
- Division of General Academic Pediatrics, Mass General Hospital for Children, Boston, MA
| | - Barry Zuckerman
- Department of Pediatrics, Boston University School of Medicine, Boston, MA
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Renbarger KM, Draucker CB. Nurses' Approaches to Pain Management for Women With Opioid Use Disorder in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2021; 50:412-423. [PMID: 33823145 DOI: 10.1016/j.jogn.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify how nurses approach pain management for women with opioid use disorder (OUD) in the perinatal period from the perspectives of nurses and women. DESIGN A secondary analysis of data from a qualitative descriptive study on the development of trust between nurses and women who use substances during the perinatal period. SETTING We interviewed the woman participants in a private conference room at a residential treatment center, and we interviewed the nurse participants over the phone. PARTICIPANTS Four women from a residential treatment center in the rural U.S. Midwest and nine nurses who were members of a local Midwestern Chapter of the Association of Women's Health, Obstetric and Neonatal Nurses. METHODS We used semistructured individual interviews, and participants were asked to describe positive, negative, and typical interactions they had with the other group to identify factors that helped or hindered the formation of trust. In the course of the interviews, four of the women and nine of the nurses described interactions centered on pain management. This information, which we summarized using content analysis, provided data related to the approaches to pain management that nurses use for women with opioid use disorder in the perinatal period. RESULTS Analysis showed that nurse participants used five approaches to pain management: Promoting Nonopioid Pain Management Strategies; Trying to Give Pain Medications on Time; Doubting or Judging Women; Withholding, Delaying, or Resisting Giving Pain Medications; and Responding to Women's Hostility. CONCLUSION Nurses should confront biases related to opioid use during pregnancy and receive training on how to manage aggressive behavior during the provision of maternity care.
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Jones E H, Klaman L S, Leiner C, da Silva Barros R, Canay R, Suarez V J, Ordoñez M RS, O’Grady E K. Comprehensive Treatment for Pregnant and/or Parenting Women with Substance Use Disorders and Their Children: A Cross-Cultural Comparison. JOURNAL OF SUBSTANCE ABUSE AND ALCOHOLISM 2021; 8:1085. [PMID: 35419488 PMCID: PMC9004721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Substance use during pregnancy and early parenting years is a well-known global public health problem, but the literature comparing treatment programs for this subpopulation across countries is limited. This article both describes three women-centered treatment programs in the United States, Brazil, and Argentina and examines similarities and differences among the programs in terms of patient characteristics. Such an analysis can better inform clinicians in the assessment and treatment of women who use substances and improve the universal understanding about them. METHODS A secondary data analysis of patient characteristics (e.g., pregnant at treatment admission) and patient history (e.g., substance dependence diagnosis, family history of substance use, co-occurring mental health issues) of reproductive age women (N=356) from substance use treatment programs in the United States, Brazil, and Argentina. RESULTS The Horizons program admitted the highest percentage of pregnant women (60%), Lua Nova (36%), and Casa Santa Clara (17%). Horizons patients (82%) were more likely to have a substance dependence diagnosis than Lua Nova (15%) or Casa Santa Clara patients (13%). Horizons patients (78%) were more likely to have a family history of substance use than Lua Nova (15%) or Casa Santa Clara (57%) patients. Horizons was also more likely than Lua Nova or Casa Santa Clara to have patients who had entered mental health treatment (70% vs. 19% vs. 9%, respectively). CONCLUSION Substance use problems that continue during pregnancy and parenting are common within different cultures and societies. These analyses identified similarities and differences in patient characteristics, history, and treatment programs. Cross-cultural comparisons of treatment approaches provide opportunities for clinicians to explore new ways of caring for this population.
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Affiliation(s)
- Hendrée Jones E
- PhD, UNC Horizons, Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, and Departments of Psychiatry and Behavioral Sciences and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University, Baltimore, MD 21205-2196 USA
| | - Stacey Klaman L
- PhD, MPH, Postdoctoral Research Fellow, Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA
| | - Catherine Leiner
- BS, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Roberto Canay
- PhD, e-Universidad del Museo Social Argentino (UMSA). Buenos Aires, Argentina
| | - Jesica Suarez V
- MA, Psychologist, General Director of Social Policies in Addictions of Buenos Aires City, Buenos Aires, Argentina
| | | | - Kevin O’Grady E
- PhD, Department of Psychology, University of Maryland, College Park, MD 20742 USA
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Patton EW, Saia K, Stein MD. Integrated substance use and prenatal care delivery in the era of COVID-19. J Subst Abuse Treat 2021; 124:108273. [PMID: 33771277 PMCID: PMC7979279 DOI: 10.1016/j.jsat.2020.108273] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/24/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic has directly impacted integrated substance use and prenatal care delivery in the United States and has driven a rapid transformation from in-person prenatal care to a hybrid telemedicine care model. Additionally, changes in regulations for take home dosing for methadone treatment for opioid use disorder due to COVID-19 have impacted pregnant and postpartum women. We review the literature on prenatal care models and discuss our experience with integrated substance use and prenatal care delivery during COVID-19 at New England's largest safety net hospital and national leader in substance use care. In our patient-centered medical home for pregnant and postpartum patients with substance use disorder, patients' early responses to these changes have been overwhelmingly positive. Should clinicians continue to use these models, thoughtful planning and further research will be necessary to ensure equitable access to the benefits of telemedicine and take home dosing for all pregnant and postpartum patients with substance use disorder.
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Affiliation(s)
- Elizabeth W Patton
- Boston University School of Medicine, Department of Obstetrics and Gynecology, 85 East Concord St, 6th Floor, Boston, MA 02118, United States of America; Boston Medical Center, 850 Harrison Ave, Boston, MA 02118, United States of America.
| | - Kelley Saia
- Boston University School of Medicine, Department of Obstetrics and Gynecology, 85 East Concord St, 6th Floor, Boston, MA 02118, United States of America; Boston Medical Center, 850 Harrison Ave, Boston, MA 02118, United States of America.
| | - Michael D Stein
- Boston University School of Public Health, Department of Health Law, Policy and Management, 715 Albany St, Talbot Building, Boston, MA 02118, United States of America.
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Medication-Assisted Treatment for Opioid Use Disorder in Pregnancy: Practical Applications and Clinical Impact. Obstet Gynecol Surv 2020; 75:175-189. [PMID: 32232496 DOI: 10.1097/ogx.0000000000000744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Opioid use disorder is increasingly common in the United States and affects many pregnancies. Given the rise in pregnancies complicated by opioid use, providers should understand the diagnosis and management of opioid use disorder in pregnancy. Objective This article focuses on screening for opioid misuse, selecting appropriate treatment for patients, initiating medication-assisted treatment in the inpatient setting, and providing appropriate peripartum care. Evidence Acquisition A PubMed search was undertaken using the following search terms: "opioid use disorder", "pregnancy," "medication assisted treatment," "buprenorphine," "methadone," "heroin," "addiction," "neonatal abstinence syndrome," and "detoxification." The search was limited to the English language publications, with most being published after 2000. Results All women should be screened for opioid use disorder during pregnancy. Opioid use has profound effects on the mother and infant. Medication-assisted treatment is the standard of care for pregnant women with opioid use disorder. Patients will require a multidisciplinary approach to management in the intrapartum and postpartum period. Conclusions Conclusions Opioid use disorder is a common, chronic condition with significant implications during pregnancy. Recognition and appropriate treatment of this disorder can optimize maternal and fetal outcomes. Conclusions Obstetricians are increasingly being challenged to manage pregnancies complicated by opioid use disorder and should be proficient in providing safe and effective care.
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O’Rourke-Suchoff D, Sobel L, Holland E, Perkins R, Saia K, Bell S. The labor and birth experience of women with opioid use disorder: A qualitative study. Women Birth 2020; 33:592-597. [DOI: 10.1016/j.wombi.2020.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/18/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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Paris R, Herriott AL, Maru M, Hacking SE, Sommer AR. Secrecy Versus Disclosure: Women with Substance Use Disorders Share Experiences in Help Seeking During Pregnancy. Matern Child Health J 2020; 24:1396-1403. [PMID: 33025236 DOI: 10.1007/s10995-020-03006-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Substance misuse during pregnancy can be harmful to the health of both mothers and infants. Existing recovery services or prenatal care for pregnant women with substance use disorders (SUD) in the U.S. and other countries typically fall short in providing the necessary specialized care women with SUDs need. Disclosure of substance misuse is one key factor in gaining access to specialized prenatal care; yet, barriers such as social stigma and internal shame and guilt lead many women to under-report any substance misuse during their pregnancy. This study sought to understand the process of how and why pregnant women with SUDs choose to disclose or not disclose their substance misuse to their providers when seeking prenatal care. METHODS Data were collected through interviews with N = 21 women with SUDs in the northeast U.S. whose young children had been exposed to opioids, cocaine, or MAT in utero. Thematic, inductive analysis using line-by-line coding was conducted to understand the perspectives of the women. RESULTS The women's narratives suggested a clear tension regarding whether to disclose their substance misuse to any providers during their pregnancy. Four themes describing the process of disclosure or non-disclosure were found, including reasons for and ways of being secret or choosing to disclose their substance misuse during pregnancy. CONCLUSIONS FOR PRACTICE The centrality of shame, guilt, and stigma regarding substance misuse must be addressed by medical and mental health providers in order to increase disclosure and improve access to care for women with SUDs.
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Affiliation(s)
- Ruth Paris
- Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA.
| | - Anna L Herriott
- School of Social Service Administration, University of Chicago, Chapin Hall, Hyde Park Campus, Chicago, IL, 60637, USA
| | - Mihoko Maru
- Boston University School of Social Work, 264 Bay State Road, Boston, MA, 02215, USA
| | - Sarah E Hacking
- The Home for Little Wanderers, Preschool Outreach Program, 780 American Legion Highway, Roslindale, MA, 02131, USA
| | - Amy R Sommer
- Jewish Family & Children's Service, 1430 Main St., Waltham, MA, 02451, USA
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Hadland SE, Jent VA, Alinsky RH, Marshall BDL, Mauro PM, Cerdá M. Opioid Use Disorder Treatment Facilities With Programs for Special Populations. Am J Prev Med 2020; 59:e125-e133. [PMID: 32448551 PMCID: PMC7484197 DOI: 10.1016/j.amepre.2020.03.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/19/2020] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Special populations, including veterans, pregnant and postpartum women, and adolescents, benefit from opioid use disorder treatment tailored to their specific needs, but access to such services is poorly described. This study identifies the availability of opioid use disorder treatment facilities that use medications and have special programming and contextualizes facilities amid counties' opioid-related overdose mortality. METHODS Data were compiled on 15,945 U.S. treatment facilities using medications for opioid use disorder listed in the Behavioral Health Services Treatment Locator in 2018. Facilities with programs tailored to special populations (veterans, pregnant and postpartum women, and adolescents) were identified and geocoded. Counties with such facilities were characterized. Cold spots (county clusters with poor treatment availability) were identified using Getis-Ord Gi* statistics. Data were extracted in October 2018 and analyzed from October 2018 to May 2019. RESULTS Of all 3,142 U.S. counties, 1,889 (60.1%) had opioid use disorder treatment facilities. Facilities with tailored programs for veterans, pregnant and postpartum women, and adolescents were located in 701 (22.3%), 918 (29.2%), and 1,062 (33.8%) of the counties, respectively. Specific medications provided for opioid use disorder varied, with only a minority of facilities offering methadone (among facilities with tailored programs for veterans, 6.0%; pregnant and postpartum women, 13.2%; adolescents, 1.3%). Many counties reporting opioid-related overdose deaths lacked programs for special populations (veterans, 72.6%; pregnant and postpartum women, 54.8%; adolescents, 30.6%). Cold spots were located throughout the Midwest, U.S. Southeast, and portions of Texas. CONCLUSIONS Facilities using medications for opioid use disorder with tailored programs for veterans, pregnant and postpartum women, and adolescents are limited. There is a need for improved access to evidence-based programs that address the unique treatment needs of special populations.
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Affiliation(s)
- Scott E Hadland
- Department of Pediatrics/Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts; Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
| | - Victoria A Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York
| | - Rachel H Alinsky
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Pia M Mauro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York
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"I didn't want to be on Suboxone at first…" - Ambivalence in Perinatal Substance Use Treatment. J Addict Med 2020; 13:264-271. [PMID: 30585875 DOI: 10.1097/adm.0000000000000491] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objectives of this article are to present findings from recent qualitative research with patients in a combined perinatal substance use treatment program in Central Appalachia, and to describe and analyze participants' ambivalence about medication-assisted treatment for opioid use disorder (OUD), in the context of widespread societal stigma and judgement. METHODS We conducted research in a comprehensive outpatient perinatal substance use treatment program housed in a larger obstetric practice serving a large rural, Central Appalachian region. The program serves patients across the spectrum of substance use disorders but specifically offers medication-assisted treatment to perinatal patients with OUD. We purposively and opportunistically sampled patients receiving prescriptions for buprenorphine or buprenorphine-naloxone dual product, along with prenatal care and other services. Through participant-observation and semi-structured interviews, we gathered qualitative data from 27 participants, in a total of 31 interviews. We analyzed transcripts of interviews and fieldnotes using modified Grounded Theory. RESULTS Participants in a combined perinatal substance use treatment program value supportive, non-judgmental care but report ambivalence about medication, within structural and institutional contexts of criminalized, stigmatized substance use and close scrutiny of their pregnancies. Women are keenly aware of the social and public consequences for themselves and their parenting, if they begin or continue medication treatment for OUD. CONCLUSIONS Substance use treatment providers should consider the social consequences of medication treatment, as well as the clinical benefits, when presenting treatment options and recommendations to patients. Patient-centered care must include an understanding of larger social and structural contexts.
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Kunstmann W, Specka M, Wodarz N, Scherbaum N. [Scientific Rationale for the Directive on Opioid Substitution Treatment of the German Medical Association: A Summary]. DAS GESUNDHEITSWESEN 2020; 82:915-919. [PMID: 32610357 DOI: 10.1055/a-1173-9588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND According to the Narcotic Drugs Prescription Ordinance (BtMVV), the German Medical Association was commissioned to issue a directive on opioid substitution treatment (OST) based on the current state of scientific medical knowledge. METHOD For the publication of the initial version of the German Medical Association's directive in 2002, an extensive literature research had been conducted, categorizing the results by levels of evidence. Subsequent revisions in 2010 and 2017 included recent systematic reviews, studies of evidence levels I-III and international guidelines. RESULTS OST showed its potential in the pursuit of health- and addiction-related as well as psychological and social goals. There was a decline in the rate of mortality, and high risk consumption of illegally acquired opioids was eliminated in 70 to 80% of patients in OST. Psycho-social assistance was found to enhance treatment outcome. Scientific evidence was lacking for the identification of patient groups suitable for different duration of take-home prescription. CONCLUSIONS With its 2017 amendment, the guideline of the German Medical Association was revised on the basis of the current state of science on substitution treatment. This creates more legal certainty for doctors, and treatment can be delivered in accordance with the existing scientific knowledge. Whether the effects of OST observed in this study have an impact on the care of opioid addicts by attracting more doctors to participate in their treatment needs further evaluation.
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Affiliation(s)
- Wilfried Kunstmann
- Dezernat 1 - Versorgung und Bevölkerungsmedizin, Bundesärztekammer, Berlin
| | - Michael Specka
- Klinik für Psychiatrie und Psychotherapie, LVR-Klinikum Essen, Essen
| | - Norbert Wodarz
- Zentrum für Suchtmedizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Regensburg, Regensburg
| | - Norbert Scherbaum
- Klinik für Psychiatrie und Psychotherapie, LVR-Klinikum Essen, Essen
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50
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Corsi DJ, Hsu H, Fell DB, Wen SW, Walker M. Association of Maternal Opioid Use in Pregnancy With Adverse Perinatal Outcomes in Ontario, Canada, From 2012 to 2018. JAMA Netw Open 2020; 3:e208256. [PMID: 32725246 DOI: 10.1001/jamanetworkopen.2020.8256] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A recent epidemic of opioid abuse has been described in many communities, although population-based data on trends in use in pregnancy and perinatal outcomes after in utero exposure remain limited. OBJECTIVE To assess trends in prenatal opioid use and the potential association between prenatal opioid use and preterm birth and adverse perinatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study covered live births and stillbirths among adolescents and women 15 years and older from April 1, 2012, to March 31, 2018, in Ontario, Canada. Data were analyzed from July 29 to October 15, 2019. EXPOSURES Any opioid use in pregnancy, ascertained through self-reporting and routine prenatal care. MAIN OUTCOME AND MEASURES The primary outcome was preterm birth before a gestational age of 37 weeks. Separate indicators for birth occurring at gestational ages of 34 to 36 weeks (plus 6 to 7 days; late preterm), 32 to 33 weeks (plus 6 to 7 days), 28 to 31 weeks (plus 6 to 7 days), and less than 28 weeks (very preterm birth). Secondary outcomes included small for gestational age, stillbirth, transfer to neonatal intensive care, and 5-minute Apgar score. Coarsened exact matching techniques and Poisson regression models were used to estimate the risk difference and relative risk (RR) of outcomes associated with cannabis exposure to control for confounding. RESULTS Among 710 911 women included in the analytic sample (mean [SD] age, 30.4 [5.3] years), 8059 used opioids (1.1%), with prevalence decreasing from 1.31% (95% CI, 1.25%-1.38%) in fiscal year 2012-2013 to 1.05% (95% CI, 0.99%-1.11%) in fiscal year 2017-2018 (P < .001 for trend). Use was highest among women in the lowest quintile of area-level income (2.36% vs 0.56% in the highest quintile; RR, 3.86; 95% CI, 3.58-4.15) and did not decrease over time in this group (from 2.63% [95% CI, 2.41%-2.87%] in 2012-2013 to 2.35% [95% CI, 2.14%-2.58%] in 2017-2018; P = .23 for trend). The crude rate of preterm birth at a gestational age of less than 37 weeks was 14.0% (n = 1127) among women with reported use in pregnancy and 6.0% (n = 42 226) among women who did not use opioids in the unmatched cohort. The adjusted RR for preterm birth before a gestational age of 37 weeks was 1.63 (95% CI, 1.52-1.75) among opioid users compared with nonusers and 1.77 (95% CI, 1.35-2.31) for preterm birth before 32 weeks. Among newborns, risk for neonatal intensive care was 40.5% with perinatal exposure to opioids compared with 13.9% in unexposed infants (RR, 2.91; 95% CI, 2.80-3.03). CONCLUSIONS AND RELEVANCE Rates of opioid use in pregnancy have declined in recent years, although use remains significantly higher among lower-income women. In this large population-based cohort, opioid use in pregnancy was associated with an increased risk of preterm birth and admission to a neonatal intensive care unit.
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Affiliation(s)
- Daniel J Corsi
- OMNI Research Group, Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Helen Hsu
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Shi Wu Wen
- OMNI Research Group, Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Walker
- OMNI Research Group, Clinical Epidemiology Program, Centre for Practice Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
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