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Straub L, Bateman BT, Hernández-Díaz S, Zhu Y, Suarez EA, Vine SM, Jones HE, Connery HS, Davis JM, Gray KJ, Lester B, Terplan M, Zakoul H, Mogun H, Huybrechts KF. Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone. JAMA 2024; 332:805-816. [PMID: 39133511 PMCID: PMC11320336 DOI: 10.1001/jama.2024.11501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/28/2024] [Indexed: 08/13/2024]
Abstract
Importance Buprenorphine combined with naloxone is commonly used to treat opioid use disorders outside of pregnancy. In pregnancy, buprenorphine alone is generally recommended because of limited perinatal safety data on the combination product. Objective To compare perinatal outcomes following prenatal exposure to buprenorphine with naloxone vs buprenorphine alone. Design, Settings, and Participants Population-based cohort study using health care utilization data from Medicaid-insured beneficiaries in the US from 2000 to 2018. The cohort was restricted to pregnant individuals linked to their liveborn infants, with maternal Medicaid enrollment from 3 months before pregnancy to 1 month after delivery and infant enrollment for the first 3 months after birth, unless they died sooner. Exposure Use of buprenorphine with naloxone vs buprenorphine alone during the first trimester based on outpatient dispensings. Main Outcomes and Measures Outcomes included major congenital malformations, low birth weight, neonatal abstinence syndrome, neonatal intensive care unit admission, preterm birth, respiratory symptoms, small for gestational age, cesarean delivery, and maternal morbidity. Confounder-adjusted risk ratios were calculated using propensity score overlap weights. Results This study identified 3369 pregnant individuals exposed to buprenorphine with naloxone during the first trimester (mean [SD] age, 28.8 [4.6] years) and 5326 exposed to buprenorphine alone or who switched from the combination to buprenorphine alone by the end of the first trimester (mean [SD] age, 28.3 [4.5] years). When comparing buprenorphine combined with naloxone with buprenorphine alone, a lower risk for neonatal abstinence syndrome (absolute risk, 37.4% vs 55.8%; weighted relative risk, 0.77 [95% CI, 0.70-0.84]) and a modestly lower risk for neonatal intensive care unit admission (absolute risk, 30.6% vs 34.9%; weighted relative risk, 0.91 [95% CI, 0.85-0.98]) and small for gestational age (absolute risk, 10.0% vs 12.4%; weighted relative risk, 0.86 [95% CI, 0.75-0.98]) was observed. For maternal morbidity, the comparative rates were 2.6% vs 2.9%, respectively, and the weighted relative risk was 0.90 (95% CI, 0.68-1.19). No differences were observed with respect to major congenital malformations overall, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery. Results were consistent across sensitivity analyses. Conclusions and Relevance There were similar and, in some instances, more favorable neonatal and maternal outcomes for pregnancies exposed to buprenorphine combined with naloxone compared with buprenorphine alone. For the outcomes assessed, compared with buprenorphine alone, buprenorphine with naloxone during pregnancy appears to be a safe treatment option. This supports the view that both formulations are reasonable options for the treatment of opioid use disorder in pregnancy, affirming flexibility in collaborative treatment decision-making.
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Affiliation(s)
- Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Suarez
- Center for Pharmacoepidemiology and Treatment Science, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
| | - Seanna M. Vine
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hendrée E. Jones
- UNC Horizons and Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill
| | - Hilary S. Connery
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jonathan M. Davis
- Department of Pediatrics, Tufts Medical Center and Tufts Clinical and Translational Science Institute, Boston, Massachusetts
| | - Kathryn J. Gray
- Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - Barry Lester
- Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Women & Infants Hospital, Providence, Rhode Island
| | | | - Heidi Zakoul
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Miller EA, DeVeaugh-Geiss AM, Chilcoat HD. Opioid use disorder (OUD) and treatment for opioid problems among OUD symptom subtypes in individuals misusing opioids. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100220. [PMID: 38414666 PMCID: PMC10897812 DOI: 10.1016/j.dadr.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
Background In 2021, approximately 60 million individuals worldwide and 9 million individuals in the United States (US) reported opioid misuse. In the US, 2.5 million have OUD, of which only about a third receive any substance abuse treatment. OUD is often regarded as a monolithic disorder but different opioid problem subtypes may exist beyond DSM-IV/5 criteria. Understanding the characteristics of these subtypes could be useful for informing treatment and intervention strategies. Methods Latent class analysis was used to identify OUD symptom subtypes among persons in the US who reported misusing prescription opioids or heroin in the 2015-2018 National Survey on Drug Use and Health (n=10,928). Regression analyses were utilized to determine associations between class membership and treatment receipt, as well as demographic characteristics and other comorbid conditions. Results Five classes were identified with unique OUD symptom patterns: Class 1: Asymptomatic (71.6%), Class 2: Tolerance/Time (14.5%), Class 3: Loss of Control/Pharmacological (LOC/Pharmacol) (5.7%), Class 4: Social Impairment (2.6%), and Class 5: Pervasive (5.6%). Nearly all persons in the LOC/Pharmacol, Social Impairment, and Pervasive classes met criteria for OUD (98-100%); however, they differed in receipt of past-year treatment for substance use (28%, 28%, 49%, respectively). Age, race, education, insurance status, and criminal activity were also associated with treatment receipt. Conclusions There were considerable differences in OUD symptom patterns and substance use treatment among individuals who misused opioids. The findings indicate a substantial unmet need for OUD treatment and point to patterns of heterogeneity within OUD that can inform development of treatment programs.
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Affiliation(s)
- Emily A. Miller
- Virginia Commonwealth University School of Pharmacy, 410 N 12th St, Richmond, VA 23298, USA
| | | | - Howard D. Chilcoat
- Indivior, Inc., 10710 Midlothian Turnpike, Suite 125, North Chesterfield, VA 23235, USA
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
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Tauscher JS, DePue MK, Swank J, Salloum RG. Determinants of preference for telehealth versus in-person treatment for substance use disorders: A discrete choice experiment. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 146:208938. [PMID: 36880898 DOI: 10.1016/j.josat.2022.208938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 09/06/2022] [Accepted: 12/30/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Access to substance use disorder (SUD) treatment remains a significant issue in the United States. Telehealth has potential for increasing access to services; however, it is underutilized in SUD treatment compared to mental health treatment. This study uses a discrete choice experiment (DCE) to examine stated preferences for telehealth (videoconferencing, text-based + video, text only) versus in-person SUD treatment (community-based, in-home) and the attributes (location, cost, therapist choice, wait time, evidence-based practices) most important when choosing between modalities. Subgroup analyses are reported about preference differences based on type of substance and substance use severity. METHODS Four hundred participants completed a survey containing a DCE with eighteen choice sets, the alcohol use disorders inventory test, drug abuse screening test, and a brief demographic questionnaire. The study collected data between April 15, 2020, and April 22, 2020. Conditional logit regression provided a measure of strength for participant preferences for technology-assisted treatment compared to in-person care. The study provides willingness to pay estimates as a real-world measure for the importance of each attribute in participants' decision-making. RESULTS Telehealth options that include a video conference option were equally preferrable to in-person care modalities. Text-only treatment was significantly less preferable to all other modalities of care. The ability to choose one's own therapist was a significant driver of treatment preference beyond modality, while wait time did not appear significant in making decisions. Participants with the most severe substance use differed in that they were open to text-based care without video conferencing, did not express a preference for evidence-based care, and valued therapist choice significantly more than those with only moderate substance use. CONCLUSIONS Telehealth for SUD treatment is equally preferable to in-person care offered in the community or at home, signifying preference is not a barrier for utilization. Text-only modalities may be enhanced by offering videoconference options for most individuals. Individuals with the most severe substance use issues may be willing to engage in text-based support without synchronous meetings with a provider. This approach may offer a less intensive method to engage individuals in treatment who may not otherwise access services.
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Affiliation(s)
- Justin S Tauscher
- BRiTE Center, Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - M Kristina DePue
- Department of Human Development, Family Science, and Counseling, University of Nevada- Reno, Reno, NV, USA; School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA.
| | - Jacqueline Swank
- School of Human Development and Organizational Studies, College of Education, University of Florida, Gainesville, FL, USA; Department of Educational, School, and counseling Psychology, College of Education & Human Development, University of Missouri, Columbia, MO, USA.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
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Shan JC, Chen IM, Lin PH, Chen WJ, Liao SC, Lee MB, Kuo PH. Associations between lifetime mental disorders and suicidal behaviors: findings from the Taiwan psychiatry morbidity survey. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1579-1589. [PMID: 35150308 DOI: 10.1007/s00127-022-02236-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND East Asia has high suicide rates but low prevalence of mental disorders. We examined the associations between prior lifetime mental disorders (mood disorders, anxiety disorders, substance use disorders, and impulse control disorders) and subsequent suicidal behaviors (suicidal ideation and attempts in the general population and suicide plans, planned attempts, and unplanned attempts in suicidal ideators) in Taiwan. METHODS This survey applied the World Mental Health Survey Composite International Diagnostic Interview to a population representative sample of noninstitutionalized adults between 2003 and 2005. Odds ratios (ORs) obtained using discrete-time survival analysis were used to estimate population attributable fractions (PAFs) of suicidal behaviors due to lifetime mental disorders. RESULTS Lifetime mental illness was a significant risk factor for subsequent suicidal behaviors (except unplanned attempts among ideators) despite the relatively low prevalence of mental disorders in people with suicidality (16.1%-35.0%). Each diagnosis increased the odds of suicidal ideation. In terms of acting on suicidal ideation, mood disorders were most strongly associated with having plans (OR = 10.0; 95% confidence interval, CI 4.3-21.1), whereas substance use disorders most strongly with either planned (OR = 27.3; 95% CI 6.3-118.5) or unplanned attempts (OR = 14.5; 95% CI 1.7-121.5). PAFs of all mental disorders on suicidality lay between 20 and 30% (except 11% of unplanned attempts among ideators). Mood, anxiety, and substance use disorders had higher PAFs than impulse control disorders. CONCLUSIONS In addition to mood disorders, considering anxiety and substance use disorders is essential in devising population-based suicide prevention strategies.
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Affiliation(s)
- Jia-Chi Shan
- Department of Psychiatry, Cathay General Hospital, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - I-Ming Chen
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan
| | - Po-Hsien Lin
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan
- Department of Psychiatry, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Wei J Chen
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17, Xuzhou Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
| | - Ming-Been Lee
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan.
- Department of Psychiatry, Shin Kong Wu Ho Su Hospital, Taipei, Taiwan.
| | - Po-Hsiu Kuo
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei, 100, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17, Xuzhou Rd., Zhongzheng Dist., Taipei, 100, Taiwan
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Tambling RR, Russell B, D'Aniello C. Where is the Family in Young Adult Substance Use Treatment? The Case for Systemic Family Therapy for Young Adults with Substance Use Disorders. Int J Ment Health Addict 2021; 20:1659-1670. [PMID: 33424512 PMCID: PMC7781401 DOI: 10.1007/s11469-020-00471-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2020] [Indexed: 01/31/2023] Open
Abstract
Despite the prevalence of SUDs, many individuals remain untreated (Grant et al., JAMA Psychiatry, 73(1), 39-45, 2016). Substance use disorders (SUDs) in young adults present unique challenges and stressors to parents of these individuals (D’Aniello et al., American Journal of Family Therapy, 2020; Kaur et al., International Journal of Community Medicine and Public Health, 5(6), 2380-2383, 2018; Shumway et al., Alcoholism Treatment Quarterly, 37(1), 75-98, 2019). Parents and caregivers often facilitate their children’s care and provide pragmatic and emotional support to their children; this high level of care is challenging to maintain, as with any chronic, relapsing condition. In the case of SUDs, the challenges caregivers face may be exacerbated by the stigma and the blame associated with parents in the development and maintenance of children’s SUDs, and the strains that come with navigating barriers related to accessing treatment in the USA. Estimates suggest that healthcare spending for substance use treatment is relatively low and few utilize therapeutic family treatment. This disconnect between widespread SUD prevalence, and service underutilization, indicates that families who need treatment are not accessing it. The present paper synthesizes the extant literature on the role of family members in SUD treatment, as families are a primary context of care for their children’s treatment across many chronic, relapsing conditions. Finally, we identify the utility of family therapy in addressing family member’s unique needs related to their loved one with a SUD, in the family and in a treatment context.
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Affiliation(s)
- Rachel R Tambling
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., U-1058, Storrs, CT 06269-1058 USA
| | - Beth Russell
- Department of Human Development and Family Sciences, University of Connecticut, 348 Mansfield Rd., U-1058, Storrs, CT 06269-1058 USA
| | - Carissa D'Aniello
- Community, Family, and Addiction Services, Texas Tech University, 2500 Broadway, Lubbock, TX 79409 USA
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