Parenthood and opioid dependence

Perceived healthcare stigma among patients in opioid substitution treatment: a qualitative study

Background

People with substance use disorders (SUD) including patients in opioid substitution treatment (OST) are subject to stigma, and have generally poor health and barriers towards seeking healthcare. Experience of stigma might negatively affect healthcare seeking, but this topic is sparsely investigated. The aim of this study was to explore OST patients’ past and present experiences of substance use stigma in healthcare settings, in order to provide insight into the challenges that people with opioid use disorder may face when using health services, and the strategies they use to cope with them.

Methods

Six focus groups with 23 OST patients were moderated by OST staff, and conducted with a questioning route focusing on health literacy. Experiences associated with stigma and its consequences that were spontaneously brought up by participants were assessed in a secondary analysis using a thematic approach.

Results

Experiences of stigma from a wide range of healthcare settings were reported. Medical records and patients’ oral information regarding substance use, OST medication or hepatitis C infection were identified as circumstances bringing unwanted attention to the SUD. Participants reported various forms of poor treatment, believed to reflect views of people with SUD as morally culpable, intimidating, curious, untrustworthy and less valuable than other patients, sometimes with tangible effects on the quality of healthcare. Stigma in healthcare settings affected healthcare seeking behaviors, and could result in patients concealing their OST status or substance use history.

Conclusion

This study highlights several aspects of perceived healthcare stigma that can shed light on difficulties that OST patients might experience when navigating the healthcare system. The results implicate a need to investigate attitudes towards OST patients, and the aptitude to deal with patients with SUD, among healthcare professionals, as well as a need for interventions addressing knowledge deficits and issues tied to values and patient reception among healthcare staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-021-00417-3.

The Efficacy of Combined Electroacupuncture and Auricular Pressure on Sleep Quality in Patients Receiving Methadone Maintenance Treatment

BACKGROUND AND OBJECTIVES

Previous studies have revealed that the electroacupuncture or auricular-point pressure as a single treatment approach is beneficial for relieving insomniac symptoms among patients under methadone maintenance treatment (MMT). This study is designed to evaluate the clinical efficacy of combining two treatments.

METHODS

This study was a randomized, controlled, crossover trial. A total of 50 participants were recruited from the Linsen Chinese Medicine and Kunming Branches of Taipei City Hospital and randomly assigned to Groups A (25 participants) and B (25 participants). In Group A (electroacupuncture at the Hegu point (LI4) and Zusanli point (ST36) and auricular-point pressure on the Shenmen point) and Group B (only auricular-point), the interventions were implemented biweekly for 4 weeks. After a 1-week washout period, a crossover of the groups was performed. Sleep quality, according to the Pittsburgh Sleep Quality Index (PSQI), and daily attendance rate of MMT were evaluated.

RESULTS

Combined therapy significantly improved sleep quality, especially in the PSQI subscales of subjective sleep quality (60.91% vs 20.93%, P < 0.05) and sleep latency (42.59% vs 11.28%, P < 0.05). A significantly higher daily attendance rate was noted in combined therapy than single therapy (87% ± 2% vs 82% ± 2%, P < 0.001).

DISCUSSION AND CONCLUSIONS

The combination of the electroacupuncture with auricular-point pressure demonstrated high efficacy for improving sleep quality and increasing MMT adherence compared with single therapy of auricular-point pressure.

SCIENTIFIC SIGNIFICANCE

Combined therapy of the electroacupuncture and auricular-point pressing should be introduced as a routine, facilitating treatment for patients under methadone maintenance. (Am J Addict 2020;00:00-00).

Efficacy of Electroacupuncture Combined with Auricular Point Pressing in Improving Mental Well-Being among Individuals with Heroin Use Disorder: A Randomized Controlled Crossover Trial and Pilot Study

Objective

To evaluate the clinical efficacy of combining electroacupuncture with auricular point pressing in improving quality of life of individuals with heroin use disorder undergoing methadone maintenance treatment.

Design

A randomized controlled crossover trial.

Subjects

50 participants were recruited from Taipei City Hospital, Linsen Chinese Medicine and Kunming branches, and randomly allocated to treatment groups.

Method

The 36-Item Short Form Health Survey (SF-36) was used. Group A received electroacupuncture at the Hegu (LI4) and Zusanli (ST36) and auricular point pressing on Ear Shenmen, and Group B received only auricular point pressing on Ear Shenmen biweekly for 4 weeks. After a 1-week washout period, crossover of the groups was performed.

Results

The SF-36 mental component scores of the combined treatment group improved relative to the single treatment group (11.09 vs. 10.33, p=0.023). Methadone dosage was reduced in both groups (combined therapy group: 8.58 ± 4.17/7.76 ± 4.11 (baseline/posttreatment) vs. single therapy group: 8.36 ± 4.20/8.30 ± .28, p=0.001).

Conclusion

Combined therapy of high-frequency electroacupuncture with auricular point pressing had better efficacy in enhancing quality of life, especially for mental well-being, and in gradually reducing methadone dosage.

The Impact of the Opioid Epidemic on Children and Adolescents

Although an epidemic of opioid-related overdose deaths has continued to increase in the United States for 2 decades, the impact of opioid use disorders (OUDs) on children and families receives minimal attention. The purpose of this commentary was to provide an overview of the impact of the opioid epidemic on children and adolescents, as well as to summarize challenges to improving outcomes for children. Children and adolescents who grow up in households with opioid misuse and OUDs may experience a myriad of adverse consequences, including: increased risk of mental health problems and drug use; accidental opioid poisoning; increased risk of developing a substance use disorder; and family dissolution that results from parents' incarceration, foster care placement, or loss of parent to an opioid overdose. Parental drug use may result in child neglect or deficits in parent-child attachment, and parents with an OUD may be less likely to be reunified with their children. OUD treatment is effective at reducing parental opioid use and improving child outcomes; however, stigma and cross-system collaboration may limit access to treatment and timely reunification of families. Children are the most vulnerable witnesses of the opioid epidemic, and further research is urgently needed to expand prevention interventions.

Traditional Chinese medicine-facilitated treatments may relieve anxiety symptoms during drug switching from methadone to buprenorphine/naloxone for treating opioid dependence

This study investigated a 51-year-old married man with a history of heroin dependence who underwent methadone maintenance treatment for 7 years. He received traditional Chinese medicine (TCM)-facilitated treatments and switched from methadone to buprenorphine/naloxone. Strong anxiety symptoms were observed during the initial stage; therefore, we prescribed a combination of Chaihu-Shugan-San, Zhi Bai Di Huang and Chin-Gin-Kuan-Ming decoction as the major herbal synergic regimen to relieve the symptoms of opioid withdrawal, anxiety and insomnia. During the treatment course, no precipitating withdrawal syndromes were noted, and the subject was gradually relieved of his anxiety symptoms through continual TCM treatments. In conclusion, TCM is effective in facilitating the switch from methadone to buprenorphine/naloxone and relieving anxiety symptoms. Therefore, focus on TCM-facilitated treatments for heroin dependence should be increased.

Substance Misuse–Related Parental Child Maltreatment

In Australia, children removed from the parental home because substance use–related child maltreatment issues are commonly placed in grandparent custodial care; however, the longer term relational costs of this approach have yet to be determined. Conventional, summative, and directive content analyses were conducted on data extracted from 88 Australian custodial grandparent completed Grandcarer Needs, Wellbeing and Health Surveys. Conventional analysis revealed the most common reason grandparents gave for their assumption of custodial care was drug use–related acts of parental child maltreatment. Summative analysis revealed antidepressants, marijuana, Valium, ice, and amphetamines were the most commonly used parental drugs and that these drugs were frequently used in combination with dexamphetamine, antipsychotics, heroin, ecstasy, and cocaine. Directed analysis contextualized the strain that drug use–related custodial caregiving places on grandparents’ financial resources, and how this strain is burdensome when the grandparents’ annual income is less than Aus$80,000. It also contextualizes the need for future research to explore family reunification desires/barriers.

Mother-child interaction and cognitive development in children prenatally exposed to methadone or buprenorphine

OBJECTIVE

To assess the influence of mother-child interaction on children's cognitive development in a group of children prenatally exposed to methadone or buprenorphine.

STUDY DESIGN

The study is part of a prospective longitudinal project investigating the development of children born to women in opioid maintenance therapy (OMT). The sample includes 67 children born between 2005 and 2007, 35 of which prenatally exposed to either methadone or buprenorphine and 32 non-exposed comparison children.

RESULTS

Both groups scored within the normal range of development. However, the OMT group scored significantly lower on measures of cognitive development and mother-child interaction compared to the comparison group. Cognitive development was found to be affected by both group status, F(1,54)=5.65, p=0.02, η(2)=0.10 and mother-child interaction F(1,54)=5.26, p=0.03, η(2)=0.09. Behavioral inhibition (statue), sensorimotor function (imitating hand positions), and short-term memory (sentences) was influenced by group status while narrative memory and vocabulary were found to be more influenced by mother-child interaction.

CONCLUSIONS

Different risk factors may influence different cognitive functions in children of women in OMT. Specifically, language-related cognitive skills may be more related to mother-child interaction while performance in higher cognitive functions requiring precise control over sensorimotor responses may be more sensitive to other factors such as prenatal OMT exposure, genetics, and/or prenatal exposure to other substances.