NATIONAL PERINATAL ASSOCIATION 2014 CONFERENCE - Detoxification vs. Maintenance Treatment (methadone or buprenorphine) in Pregnancy:
The participant will be able to: Compare the benefits
and risks of opioid maintenance and opioid
detoxification in pregnancy.
Detoxification vs. Maintenance Treatment (methadone or buprenorphine) in Pre...ErikaAGoyer
This document discusses opioid dependence in pregnancy, focusing on treatment options of detoxification versus maintenance. It provides an overview of the prevalence of opioid use in pregnancy, risks to both mother and baby, and treatment challenges. The key treatment options presented are detoxification, which carries risk of relapse but reduces neonatal abstinence syndrome, versus methadone or buprenorphine maintenance, which improves outcomes but results in continued opioid exposure. Integrated prenatal care and addiction treatment is emphasized as optimal, with challenges including lack of resources and nonadherence.
Neonatal Abstinence Syndrome - Tennessee's Epidemic and The State's ResponseHealth Easy Peasy
This document discusses neonatal abstinence syndrome (NAS) in Tennessee. It defines NAS as withdrawal symptoms in newborns exposed to drugs like opioids prenatally. The rate of NAS hospitalizations in Tennessee increased dramatically from 1999-2012, mirroring the rise in prescription opioid use. In 2012, Tennessee had the second highest rate of prescription painkillers sold and the highest number of opioid prescriptions per capita nationally. The document outlines Tennessee's efforts to address NAS through a cabinet-level working group and legislative actions focused on prevention, treatment, and monitoring of prescription drug use and opioid-exposed pregnancies.
This document provides an overview of addiction and pregnancy, including:
- Rates of drug and alcohol use during pregnancy range from 12-24% and pose risks to fetal development.
- Treatment includes medication-assisted therapy with methadone or buprenorphine, which can improve outcomes compared to untreated addiction.
- Babies exposed to opioids in utero may develop neonatal abstinence syndrome requiring supportive care and sometimes pharmacological treatment.
This document provides an overview of opioid dependency during pregnancy. It discusses the scope of the opioid crisis, risks of untreated addiction during pregnancy, screening and treatment options. The main treatment options discussed are methadone and buprenorphine maintenance therapy, which are the recommended standards of care. Risks of untreated addiction include poor prenatal care and higher rates of complications. Screening practices and neonatal opioid withdrawal syndrome are also covered. The summary emphasizes continued medication-assisted treatment is best practice and discourages punitive approaches to pregnant women with opioid use disorders.
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
- Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
Overview of Neonatal Abstinence Syndrome (NAS), a drug withdrawal syndrome resulting from sudden discontinuation of prolonged fetal exposure in utero. Topics include epidemiology, health care expenditures, pathophysiology, clinical presentation, management, and long-term outcomes.
Major medical organizations have differing views on neonatal circumcision (NC):
- US organizations acknowledge potential medical benefits but say evidence is not sufficient to recommend routine NC. Parental choice is emphasized.
- Canadian, British, and Dutch organizations oppose routine NC due to lack of medical necessity and ethical concerns about consent.
- WHO recommends NC in sub-Saharan Africa to help reduce HIV rates.
Overall positions range from acknowledging potential medical benefits to saying NC provides no benefit and may cause harm, but most support parental choice based on cultural or religious preferences. Insurance coverage also impacts circumcision rates.
Detoxification vs. Maintenance Treatment (methadone or buprenorphine) in Pre...ErikaAGoyer
This document discusses opioid dependence in pregnancy, focusing on treatment options of detoxification versus maintenance. It provides an overview of the prevalence of opioid use in pregnancy, risks to both mother and baby, and treatment challenges. The key treatment options presented are detoxification, which carries risk of relapse but reduces neonatal abstinence syndrome, versus methadone or buprenorphine maintenance, which improves outcomes but results in continued opioid exposure. Integrated prenatal care and addiction treatment is emphasized as optimal, with challenges including lack of resources and nonadherence.
Neonatal Abstinence Syndrome - Tennessee's Epidemic and The State's ResponseHealth Easy Peasy
This document discusses neonatal abstinence syndrome (NAS) in Tennessee. It defines NAS as withdrawal symptoms in newborns exposed to drugs like opioids prenatally. The rate of NAS hospitalizations in Tennessee increased dramatically from 1999-2012, mirroring the rise in prescription opioid use. In 2012, Tennessee had the second highest rate of prescription painkillers sold and the highest number of opioid prescriptions per capita nationally. The document outlines Tennessee's efforts to address NAS through a cabinet-level working group and legislative actions focused on prevention, treatment, and monitoring of prescription drug use and opioid-exposed pregnancies.
This document provides an overview of addiction and pregnancy, including:
- Rates of drug and alcohol use during pregnancy range from 12-24% and pose risks to fetal development.
- Treatment includes medication-assisted therapy with methadone or buprenorphine, which can improve outcomes compared to untreated addiction.
- Babies exposed to opioids in utero may develop neonatal abstinence syndrome requiring supportive care and sometimes pharmacological treatment.
This document provides an overview of opioid dependency during pregnancy. It discusses the scope of the opioid crisis, risks of untreated addiction during pregnancy, screening and treatment options. The main treatment options discussed are methadone and buprenorphine maintenance therapy, which are the recommended standards of care. Risks of untreated addiction include poor prenatal care and higher rates of complications. Screening practices and neonatal opioid withdrawal syndrome are also covered. The summary emphasizes continued medication-assisted treatment is best practice and discourages punitive approaches to pregnant women with opioid use disorders.
Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed) - C...ErikaAGoyer
NATIONAL PERINATAL ASSOCIATION CONFERENCE 2014 - Treatment Programs HARPS Program (Helping At-Risk Pregnant Women Succeed)
- Chris Cooper, MSN, NNP-CB, APRN and Dawn Forbes, MD
Overview of Neonatal Abstinence Syndrome (NAS), a drug withdrawal syndrome resulting from sudden discontinuation of prolonged fetal exposure in utero. Topics include epidemiology, health care expenditures, pathophysiology, clinical presentation, management, and long-term outcomes.
Major medical organizations have differing views on neonatal circumcision (NC):
- US organizations acknowledge potential medical benefits but say evidence is not sufficient to recommend routine NC. Parental choice is emphasized.
- Canadian, British, and Dutch organizations oppose routine NC due to lack of medical necessity and ethical concerns about consent.
- WHO recommends NC in sub-Saharan Africa to help reduce HIV rates.
Overall positions range from acknowledging potential medical benefits to saying NC provides no benefit and may cause harm, but most support parental choice based on cultural or religious preferences. Insurance coverage also impacts circumcision rates.
Neonatal abstinence syndrome (NAS) refers to withdrawal symptoms in newborns exposed to drugs in utero. NAS is most commonly associated with opioid exposure and presents as central nervous system disturbances, gastrointestinal issues, and autonomic dysfunction. Diagnosis is based on clinical history and signs, with supportive care as first-line treatment and pharmacotherapy with morphine or other drugs as needed. Proper management aims to stabilize the newborn and facilitate healthy development.
This presentation discusses neonatal abstinence syndrome, which occurs when a newborn experiences withdrawal symptoms from exposure to addictive drugs in the womb. The presenter outlines the incidence, types, etiology, symptoms, exams/tests used for diagnosis, and management approaches for NAS. Regarding management, non-pharmacological interventions like swaddling and minimal stimulation are recommended initially. If symptoms are severe, pharmacological therapy using morphine, methadone or clonidine may be used. The roles of nurses in assessing exposed newborns, monitoring withdrawal, and coordinating multidisciplinary care are also reviewed. The presenter emphasizes the importance of prevention through screening, education, and treatment programs for pregnant women with substance use
Treat the Patient: Not the Pregnancy April 2015PASaskatchewan
This document provides information on safely managing common medical conditions during pregnancy and lactation. It discusses medication classification systems and factors affecting drug transfer across the placenta and into breastmilk. Guidelines are presented for treating depression, diabetes, thyroid disorders, infections, pain, nausea, and other issues. Many prescription and over-the-counter drugs are deemed safe to use when necessary, such as most antibiotics, acetaminophen, ranitidine, and antidepressants. Untreated medical conditions pose greater risks than potential side effects of approved medications. Resources for further information and guidance are also referenced.
Treating Pregnant Opioid Dependent Women: Examining Buprenorphine and Methadoneshabeel pn
This document summarizes research comparing the use of methadone and buprenorphine to treat opioid dependence in pregnant women. A randomized double-blind study found that while all infants exposed to either drug showed signs of neonatal abstinence syndrome, infants exposed to buprenorphine tended to require less treatment and have shorter hospital stays. Both drugs were found to provide benefits to mothers by supporting treatment adherence and prenatal care. While larger studies are still needed, the results suggest that buprenorphine may produce milder withdrawal symptoms in exposed infants. Overall, the study supports the safety and efficacy of both methadone and buprenorphine for treating opioid dependence during pregnancy.
This document discusses considerations for dental care during pregnancy and breastfeeding. It notes that while pregnant patients are not medically compromised, dental care must avoid harming the developing fetus. The first trimester poses the highest risk, so elective care is best avoided then. Routine dental care is generally safest during the second trimester. Drug use and radiation exposure should be minimized, and safe alternatives utilized. Maintaining good oral hygiene benefits both mother and child without risk.
This document provides information on polypharmacy and managing multiple medications. It defines appropriate and problematic polypharmacy. It discusses why polypharmacy is common in older patients living with multiple conditions. The document presents case studies of patients with polypharmacy and suggestions for optimizing their medications. It also provides resources for deprescribing and rationalizing polypharmacy when some medications may no longer be needed or beneficial.
This document discusses self-medication and provides guidance on how to do it safely. It defines self-medication as using medicines without consulting a doctor to treat perceived or real health issues. While self-medication can help relieve costs, it may reduce monitoring and transfer financial burden to patients. The document advises consulting a pharmacist before self-medicating and provides examples of when self-medication may not be appropriate. It emphasizes the importance of responsible self-medication by being informed about proper use, dosage, and side effects of medicines.
This document discusses dosing considerations for vulnerable patient populations including pregnant women, children, elderly patients, and those with organ impairments or weight abnormalities. It notes several groups are at high risk for adverse drug reactions and require careful dosing. Factors like developmental stage, organ function changes, body composition, and concurrent illnesses must be considered to safely and effectively treat these patients.
Drug uses in special physiology( pregnancy , lactation, infant , children, ge...Akshil Mehta
Drug use during pregnancy can affect the pharmacokinetics and pharmacodynamics of medications in complex ways due to physiological changes. Absorption, distribution, metabolism and elimination of drugs are often altered. This can increase drug effects in some cases and decrease them in others. Many factors influence whether and how much of a drug crosses the placenta to the fetus. Proper prescribing during pregnancy requires consideration of these factors and potential risks to the developing fetus. Education of pregnant women about safe and risky medications is important.
The study assessed knowledge, attitude, and practices regarding emergency contraception among 366 female students in Mekelle, Northern Ethiopia. The key findings were:
1) About 90.7% of respondents had heard of emergency contraception. Three-fourths (75.7%) had good knowledge and over half (64.9%) had a positive attitude.
2) Older age was significantly associated with greater awareness. Those over 18 were more likely to have good knowledge compared to younger students.
3) Age and ethnicity also influenced attitude - younger students and non-Tigre ethnic groups were less likely to have a positive attitude.
4) While knowledge and attitude were high, the study
WHO's Medical Eligibility Criteria: Global Contraceptive Guidance Sharon Phillips
1) The document summarizes key information from a presentation on the WHO Medical Eligibility Criteria for Contraceptive Use. It discusses the unmet need for contraception, benefits of meeting this need, and contraceptive methods.
2) It provides an overview of the WHO Medical Eligibility Criteria, which recommends the safety of contraceptive methods for people with certain health conditions. The criteria use a numeric system and were recently updated for several populations.
3) The presentation reviews two case presentations and explains the WHO recommendations for contraceptive use in women with migraines and in breastfeeding women. The guidance has been updated for these groups.
This document discusses polypharmacy in psychiatry. It defines polypharmacy as using two or more medications to treat the same or different conditions. While historically frowned upon, polypharmacy is now seen as necessary in many cases. Studies show rates of polypharmacy vary widely, from 13-90%, and have increased over time. Polypharmacy is more common in certain populations like adult men, those with schizophrenia, and the geriatric population where over 90% use at least one medication per week. While polypharmacy can increase adverse effects and interactions, it may be justified when treating co-morbidities or when mono-therapy is insufficient. Education and following guidelines can help avoid irrational polypharmacy.
The pharmacists role in drug induced nutrient depletion n. jonesPASaskatchewan
This document discusses the role of pharmacists in addressing drug-induced nutrient depletions. It provides background on how certain medications can affect nutrient levels in the body by interfering with metabolic pathways. Specific examples are given of how statin drugs may deplete coenzyme Q10 and how acid-reducing medications can impact vitamin and mineral absorption. The document advocates for pharmacists to play a greater role in counseling patients on nutritional supplementation to remedy nutrient deficiencies caused by their medications.
This document discusses several key issues related to drug use during pregnancy. Pregnant women who use drugs often face barriers to accessing prenatal services. They may not realize they are pregnant or want to continue the pregnancy. All drug-using pregnant women will need treatment to reduce harm, which can include methadone substitution or withdrawal management. Both the mother and baby are at risk - mothers may have poor nutrition, health issues, or mental health problems while babies can experience addiction and withdrawal symptoms. Close monitoring of both mother and baby is important during labor and delivery due to risks of fetal distress and neonatal abstinence syndrome.
This document discusses polypharmacy and medication errors. It begins by defining polypharmacy as the use of multiple medications where more are being used than clinically indicated. Polypharmacy can increase the risk of drug interactions and adverse events. Common risk factors for polypharmacy include the elderly, multiple comorbidities, recent hospitalization, and multiple physicians or pharmacies. Medication errors are also defined as any error in the medication use process and examples are provided. Reporting systems for medication errors and the most commonly implicated drug classes and individual drugs are outlined. Risk factors for errors and recommendations to reduce polypharmacy and errors are presented.
This document summarizes a presentation on medication-assisted treatments for substance use disorders. It discusses the use of medications to treat tobacco, alcohol, and opioid addiction. For tobacco, varenicline is recommended to reduce cravings and prevent relapse. For alcohol, disulfiram, naltrexone, and acamprosate are FDA-approved medications to prevent relapse. Characteristics and considerations for each medication are provided. The benefits of screening and brief interventions in primary care settings are also summarized.
This document summarizes key aspects of pharmacovigilance in pediatrics. It notes that drug safety profiles in children are often less well known than in adults due to limited clinical trials. Off-label use is also common in pediatrics due to a lack of approved formulations and dosing recommendations for children. Certain adverse drug reactions are specific to pediatric patients and can be related to developmental factors. Spontaneous reporting and epidemiological studies are important for monitoring drug safety in children but underreporting remains an issue. The incidence of adverse drug reactions in children varies depending on factors like treatment setting and country.
This document provides information on FDA pregnancy drug labeling categories and discusses various antidepressant and other psychotropic medications. It describes the FDA categories A through X for evaluating risks of medications during pregnancy and lists common antidepressants along with their FDA categories. For each medication class, it summarizes potential risks to the fetus or newborn based on available studies. The document emphasizes making individualized treatment decisions and monitoring for potential neonatal side effects.
Methadone maintenance treatment implementation indian experiencemailrishigupta
Methadone maintenance treatment has been implemented in India since 2012 across several government healthcare settings with over 700 clients enrolled. The document discusses the feasibility findings of setting up methadone clinics in India, including obtaining necessary approvals, selecting clinic locations, infrastructure requirements, staffing, licensing, procurement, dispensing, clinical services, quality assurance, and advocacy efforts. Overall, the experience so far demonstrates that methadone maintenance treatment can be successfully implemented in India to benefit opioid dependent clients and communities.
This document summarizes a qualitative study on methadone perspectives from people who inject drugs in Kenya. The study aimed to understand the risk environment for people who inject drugs and the impact of harm reduction services. Key findings included the limited availability of addiction treatment previously, but high hopes for a new methadone program to help manage withdrawal symptoms and support rehabilitation without needing to attend long-term residential programs. However, the methadone program had not yet started after being announced two years prior, so uncertainty and skepticism had grown about whether it would actually be implemented.
Neonatal abstinence syndrome (NAS) refers to withdrawal symptoms in newborns exposed to drugs in utero. NAS is most commonly associated with opioid exposure and presents as central nervous system disturbances, gastrointestinal issues, and autonomic dysfunction. Diagnosis is based on clinical history and signs, with supportive care as first-line treatment and pharmacotherapy with morphine or other drugs as needed. Proper management aims to stabilize the newborn and facilitate healthy development.
This presentation discusses neonatal abstinence syndrome, which occurs when a newborn experiences withdrawal symptoms from exposure to addictive drugs in the womb. The presenter outlines the incidence, types, etiology, symptoms, exams/tests used for diagnosis, and management approaches for NAS. Regarding management, non-pharmacological interventions like swaddling and minimal stimulation are recommended initially. If symptoms are severe, pharmacological therapy using morphine, methadone or clonidine may be used. The roles of nurses in assessing exposed newborns, monitoring withdrawal, and coordinating multidisciplinary care are also reviewed. The presenter emphasizes the importance of prevention through screening, education, and treatment programs for pregnant women with substance use
Treat the Patient: Not the Pregnancy April 2015PASaskatchewan
This document provides information on safely managing common medical conditions during pregnancy and lactation. It discusses medication classification systems and factors affecting drug transfer across the placenta and into breastmilk. Guidelines are presented for treating depression, diabetes, thyroid disorders, infections, pain, nausea, and other issues. Many prescription and over-the-counter drugs are deemed safe to use when necessary, such as most antibiotics, acetaminophen, ranitidine, and antidepressants. Untreated medical conditions pose greater risks than potential side effects of approved medications. Resources for further information and guidance are also referenced.
Treating Pregnant Opioid Dependent Women: Examining Buprenorphine and Methadoneshabeel pn
This document summarizes research comparing the use of methadone and buprenorphine to treat opioid dependence in pregnant women. A randomized double-blind study found that while all infants exposed to either drug showed signs of neonatal abstinence syndrome, infants exposed to buprenorphine tended to require less treatment and have shorter hospital stays. Both drugs were found to provide benefits to mothers by supporting treatment adherence and prenatal care. While larger studies are still needed, the results suggest that buprenorphine may produce milder withdrawal symptoms in exposed infants. Overall, the study supports the safety and efficacy of both methadone and buprenorphine for treating opioid dependence during pregnancy.
This document discusses considerations for dental care during pregnancy and breastfeeding. It notes that while pregnant patients are not medically compromised, dental care must avoid harming the developing fetus. The first trimester poses the highest risk, so elective care is best avoided then. Routine dental care is generally safest during the second trimester. Drug use and radiation exposure should be minimized, and safe alternatives utilized. Maintaining good oral hygiene benefits both mother and child without risk.
This document provides information on polypharmacy and managing multiple medications. It defines appropriate and problematic polypharmacy. It discusses why polypharmacy is common in older patients living with multiple conditions. The document presents case studies of patients with polypharmacy and suggestions for optimizing their medications. It also provides resources for deprescribing and rationalizing polypharmacy when some medications may no longer be needed or beneficial.
This document discusses self-medication and provides guidance on how to do it safely. It defines self-medication as using medicines without consulting a doctor to treat perceived or real health issues. While self-medication can help relieve costs, it may reduce monitoring and transfer financial burden to patients. The document advises consulting a pharmacist before self-medicating and provides examples of when self-medication may not be appropriate. It emphasizes the importance of responsible self-medication by being informed about proper use, dosage, and side effects of medicines.
This document discusses dosing considerations for vulnerable patient populations including pregnant women, children, elderly patients, and those with organ impairments or weight abnormalities. It notes several groups are at high risk for adverse drug reactions and require careful dosing. Factors like developmental stage, organ function changes, body composition, and concurrent illnesses must be considered to safely and effectively treat these patients.
Drug uses in special physiology( pregnancy , lactation, infant , children, ge...Akshil Mehta
Drug use during pregnancy can affect the pharmacokinetics and pharmacodynamics of medications in complex ways due to physiological changes. Absorption, distribution, metabolism and elimination of drugs are often altered. This can increase drug effects in some cases and decrease them in others. Many factors influence whether and how much of a drug crosses the placenta to the fetus. Proper prescribing during pregnancy requires consideration of these factors and potential risks to the developing fetus. Education of pregnant women about safe and risky medications is important.
The study assessed knowledge, attitude, and practices regarding emergency contraception among 366 female students in Mekelle, Northern Ethiopia. The key findings were:
1) About 90.7% of respondents had heard of emergency contraception. Three-fourths (75.7%) had good knowledge and over half (64.9%) had a positive attitude.
2) Older age was significantly associated with greater awareness. Those over 18 were more likely to have good knowledge compared to younger students.
3) Age and ethnicity also influenced attitude - younger students and non-Tigre ethnic groups were less likely to have a positive attitude.
4) While knowledge and attitude were high, the study
WHO's Medical Eligibility Criteria: Global Contraceptive Guidance Sharon Phillips
1) The document summarizes key information from a presentation on the WHO Medical Eligibility Criteria for Contraceptive Use. It discusses the unmet need for contraception, benefits of meeting this need, and contraceptive methods.
2) It provides an overview of the WHO Medical Eligibility Criteria, which recommends the safety of contraceptive methods for people with certain health conditions. The criteria use a numeric system and were recently updated for several populations.
3) The presentation reviews two case presentations and explains the WHO recommendations for contraceptive use in women with migraines and in breastfeeding women. The guidance has been updated for these groups.
This document discusses polypharmacy in psychiatry. It defines polypharmacy as using two or more medications to treat the same or different conditions. While historically frowned upon, polypharmacy is now seen as necessary in many cases. Studies show rates of polypharmacy vary widely, from 13-90%, and have increased over time. Polypharmacy is more common in certain populations like adult men, those with schizophrenia, and the geriatric population where over 90% use at least one medication per week. While polypharmacy can increase adverse effects and interactions, it may be justified when treating co-morbidities or when mono-therapy is insufficient. Education and following guidelines can help avoid irrational polypharmacy.
The pharmacists role in drug induced nutrient depletion n. jonesPASaskatchewan
This document discusses the role of pharmacists in addressing drug-induced nutrient depletions. It provides background on how certain medications can affect nutrient levels in the body by interfering with metabolic pathways. Specific examples are given of how statin drugs may deplete coenzyme Q10 and how acid-reducing medications can impact vitamin and mineral absorption. The document advocates for pharmacists to play a greater role in counseling patients on nutritional supplementation to remedy nutrient deficiencies caused by their medications.
This document discusses several key issues related to drug use during pregnancy. Pregnant women who use drugs often face barriers to accessing prenatal services. They may not realize they are pregnant or want to continue the pregnancy. All drug-using pregnant women will need treatment to reduce harm, which can include methadone substitution or withdrawal management. Both the mother and baby are at risk - mothers may have poor nutrition, health issues, or mental health problems while babies can experience addiction and withdrawal symptoms. Close monitoring of both mother and baby is important during labor and delivery due to risks of fetal distress and neonatal abstinence syndrome.
This document discusses polypharmacy and medication errors. It begins by defining polypharmacy as the use of multiple medications where more are being used than clinically indicated. Polypharmacy can increase the risk of drug interactions and adverse events. Common risk factors for polypharmacy include the elderly, multiple comorbidities, recent hospitalization, and multiple physicians or pharmacies. Medication errors are also defined as any error in the medication use process and examples are provided. Reporting systems for medication errors and the most commonly implicated drug classes and individual drugs are outlined. Risk factors for errors and recommendations to reduce polypharmacy and errors are presented.
This document summarizes a presentation on medication-assisted treatments for substance use disorders. It discusses the use of medications to treat tobacco, alcohol, and opioid addiction. For tobacco, varenicline is recommended to reduce cravings and prevent relapse. For alcohol, disulfiram, naltrexone, and acamprosate are FDA-approved medications to prevent relapse. Characteristics and considerations for each medication are provided. The benefits of screening and brief interventions in primary care settings are also summarized.
This document summarizes key aspects of pharmacovigilance in pediatrics. It notes that drug safety profiles in children are often less well known than in adults due to limited clinical trials. Off-label use is also common in pediatrics due to a lack of approved formulations and dosing recommendations for children. Certain adverse drug reactions are specific to pediatric patients and can be related to developmental factors. Spontaneous reporting and epidemiological studies are important for monitoring drug safety in children but underreporting remains an issue. The incidence of adverse drug reactions in children varies depending on factors like treatment setting and country.
This document provides information on FDA pregnancy drug labeling categories and discusses various antidepressant and other psychotropic medications. It describes the FDA categories A through X for evaluating risks of medications during pregnancy and lists common antidepressants along with their FDA categories. For each medication class, it summarizes potential risks to the fetus or newborn based on available studies. The document emphasizes making individualized treatment decisions and monitoring for potential neonatal side effects.
Methadone maintenance treatment implementation indian experiencemailrishigupta
Methadone maintenance treatment has been implemented in India since 2012 across several government healthcare settings with over 700 clients enrolled. The document discusses the feasibility findings of setting up methadone clinics in India, including obtaining necessary approvals, selecting clinic locations, infrastructure requirements, staffing, licensing, procurement, dispensing, clinical services, quality assurance, and advocacy efforts. Overall, the experience so far demonstrates that methadone maintenance treatment can be successfully implemented in India to benefit opioid dependent clients and communities.
This document summarizes a qualitative study on methadone perspectives from people who inject drugs in Kenya. The study aimed to understand the risk environment for people who inject drugs and the impact of harm reduction services. Key findings included the limited availability of addiction treatment previously, but high hopes for a new methadone program to help manage withdrawal symptoms and support rehabilitation without needing to attend long-term residential programs. However, the methadone program had not yet started after being announced two years prior, so uncertainty and skepticism had grown about whether it would actually be implemented.
Dr Rowan Molnar #DrRowanMolnar - Popular profiles on GoogleDr. Rowan Molnar
Dr Rowan Molnar is dedicated to medical education at all levels, particularly in establishment, deployment and implementation of simulation based teaching. Dr Rowan Molnar is a recognised leader with a demonstrated ability to constantly strive for excellence in the ever changing world of medicine.
#DrRowanMolnar, #RowanMolnar, #DrRowan, #Molnar, #DrRowanMolnarAustralia, #RowanMolnarAustralia, #DrRowanMolnarMelbourneAustralia
Stop the Stigma: Breaking the Stigma of Methadone Maintenance TreatmentChesie Roberts
This is a presentation that I give every year at the Alabama School of Alcohol and Drug Conference. I am working to break the stigma related with patients choice of methadone treatment.
This document discusses various opioid analgesics and antagonists used for pain management. It describes how opioids work by binding to receptors in the central nervous system and periphery to reduce pain transmission. The major opioid receptor types are μ, κ, and δ, with μ receptors mainly responsible for analgesia. Common opioid agonists discussed include morphine, codeine, meperidine, methadone, fentanyl, and heroin. Their mechanisms of action, therapeutic uses, pharmacokinetics, and adverse effects are summarized.
Opioids act on three types of opioid receptors in the brain and body - mu, kappa, and delta. They produce effects like analgesia, sedation, euphoria, and respiratory depression. Common opioids include morphine, codeine, oxycodone, fentanyl, and heroin. Opioids are used medically to treat severe pain but carry risks of tolerance, dependence, and overdose. Naloxone and naltrexone are opioid antagonists that can reverse the effects of opioid overdose.
The document discusses various opioid analgesics including their mechanisms of action, effects, and therapeutic uses. It describes how opioids like morphine and pethidine work in the central nervous system to provide analgesia and other effects through binding to mu, kappa, and delta opioid receptors. It also covers the pharmacokinetics, indications, adverse effects and classifications of different opioid drugs.
The document discusses opioid poisoning from substances derived from the opium poppy plant like morphine and codeine. It notes that opioids work by stimulating receptors in the central nervous system, causing sedation and respiratory depression which can lead to respiratory failure and death. Symptoms of acute opioid poisoning range from euphoria to vomiting and lethargy while chronic use can cause depression, weight loss, and social withdrawal. Treatment focuses on maintaining breathing and circulation along with the antidote naloxone to reverse effects while also providing supportive care and counseling.
Barbiturates such as thiopental and methohexital act as central nervous system depressants by enhancing the effects of the neurotransmitter GABA at GABA-A receptors. Thiopental is commonly used for induction of general anesthesia due to its rapid onset and short duration of action. It has a narrow therapeutic index, so proper dosing is important to achieve hypnosis without causing respiratory depression or cardiovascular complications. While barbiturates can provide neuroprotective effects at high doses, their use remains controversial except for certain clinical scenarios like incomplete brain ischemia. Potential adverse effects include hypotension, apnea, allergy, and tissue damage if injected intra-arterially rather than intravenously.
Barbiturates are depressants that were once commonly prescribed for anxiety, insomnia, and seizures but are now less so due to risk of addiction and overdose. They are categorized into schedules by their abuse and dependence potential, with schedule II having the highest risk. Withdrawal from long-term barbiturate use can cause severe, even life-threatening symptoms. While they still have medical uses, penalties for illegal possession and trafficking can include prison time and large fines.
Barbiturates are derivatives of barbituric acid that act as central nervous system depressants. They have multiple mechanisms of action in the brain involving GABA receptors and ion channels. Barbiturates are classified based on their duration of action and include long, intermediate, short, and ultrashort-acting varieties. While once widely used as sedatives, hypnotics, and for anesthesia, barbiturates have significant disadvantages like low therapeutic index, drug interactions, abuse potential, and severe withdrawal syndrome. Newer agents like benzodiazepines, buspirone, zolpidem, and zaleplon have replaced barbiturates for most indications due to safer profiles
This document discusses opioid analgesics, including their classification, mechanisms of action, and effects. It begins by defining analgesics, opioids, opiates, and narcotics. It then discusses the opioid morphine in depth, including its pharmacological effects in the central nervous system and peripherally. Other opioids discussed include pethidine, methadone, tramadol, endogenous opioid peptides, and opioid receptor antagonists such as naloxone. The document provides an overview of the classification, properties, uses, and adverse effects of various opioid analgesics.
This document discusses opioids, their classification, pharmacological actions, routes of administration, metabolism, toxicity, and withdrawal. It describes how opioids work on mu, kappa, and delta receptors to produce analgesia, sedation, respiratory depression and other effects. It outlines the treatment for opioid overdose including naloxone administration and activated charcoal. Symptoms and management of opioid withdrawal are also reviewed.
The document discusses opioids, including their definition, sources, receptors, history of use, classifications, mechanisms of action, pharmacological effects, adverse effects, toxicity, and therapeutic uses. It describes the three main opioid receptors (mu, kappa, delta), the effects of receptor activation, and different classifications of opioids based on their receptor actions (agonists, partial agonists, antagonists, mixed). It covers the absorption, distribution, metabolism and excretion of opioids. The major pharmacological actions discussed are analgesia, sedation, respiratory depression, nausea, constipation, and dependence/withdrawal. Therapeutic uses include management of severe pain and obstetrical labor pain. Risks/cautions with impaired organ function and certain patient populations
This document summarizes the pharmacology of various opioid analgesics. It discusses classical opioid effects like analgesia, sedation, respiratory depression. It then profiles specific opioids like fentanyl, sufentanil, morphine, hydromorphone, remifentanil and others. It also discusses evidence for different mu opioid receptor subtypes and the potential for mu-1 selective agonists.
This document discusses issues related to drug exposed infants. It provides information on an upcoming conference on drug exposed infants including accepted learning objectives, disclosure statements, and trends in drug use during pregnancy. Specific drugs discussed include nicotine, alcohol, benzodiazepines, marijuana, stimulants, cocaine, and opiates. Information is presented on trends in neonatal abstinence syndrome, mechanisms of action and effects of various opioids including methadone and buprenorphine. The document also discusses complications of chronic opiate use for both mother and fetus, and recommendations for screening, treatment and recognizing neonatal withdrawal.
This document provides information on screening and treating substance use disorders during pregnancy. It discusses:
- Trends in substance abuse among pregnant women, including illicit drugs, alcohol, tobacco.
- The importance of screening all pregnant patients for substance use, using tools like the 2-item screen and 4Ps Plus screen. Any positive response indicates risk and need for further assessment.
- Treatment options for common substance use disorders in pregnancy, including opiate use disorder, alcohol use disorder, and tobacco addiction. Medication assisted treatment is recommended for opiate use disorder.
This document summarizes a presentation on research related to intrauterine drug exposure and neonatal abstinence syndrome (NAS). It provides background on the presenters and their disclosures. The objectives are then outlined, including defining key terms, outlining short and long-term impacts of drug exposure and NAS, genetic factors associated with NAS outcomes, and standards of care for addiction in pregnancy. Details from the various presentation sections are then provided on topics like opioid prescriptions, NAS rates and costs, maternal complications, and neonatal outcomes of exposed infants.
The document discusses the teratogenicity of psychotropic drugs. It notes that while mental illness in mothers poses risks, discontinuing medication during pregnancy may not be possible. The guiding principles are to minimize exposure to untreated illness and psychotropics, continue prior effective medications, and monitor infants for potential drug effects if exposed during lactation or late pregnancy. Risks include teratogenesis, perinatal effects, and potential long-term neurodevelopmental impacts, though studies have shown mixed results. Among SSRIs, paroxetine carries greater risks while sertraline and citalopram generally pose less risk and are considered first-line treatments.
challenges in obstetric prescription
Beautiful Slide Show By Editor Dr. Ragini Agrawal And Dr. Tamkeen khan
Dr. Ragini Agrawal, Chairperson Food , Drug & medico surgical Equipment Committee 2009-2011
This document discusses the growing epidemic of prescription opioid addiction among women in Ontario. Some key points:
- Prescription opioid misuse has risen dramatically in Ontario over the last decade, with close to 39,000 individuals now on methadone treatment. Women are particularly at risk given higher prescription rates and faster progression to addiction.
- Women experience higher rates of chronic pain conditions and are more likely to be prescribed and continue taking opioids long-term, putting them at increased risk of addiction. A host of social and biological factors like relationships, trauma history, and concurrent mental health issues can also accelerate a woman's progression to opioid dependence.
- Effective treatment needs to address the underlying risk factors like trauma, mental health issues,
As presented at The Royal by:
- Dr. Melanie Willows, Clinical Director, SUCD Program, The Royal
- Dr. Kim Corace, Director, Program Development and Research, SUCD Program, The Royal
Opioid addiction is a large and growing problem affecting our community, especially our young people, women and their families. This session addressed:
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· Opioid use, abuse, and addiction as it relates to women and parenting
· Risk factors for opioid use about women, with a focus on mental health problems
· Treatment options to help women who struggle with opioid problems
· Reducing the stigma and myths regarding women with opioid use problems
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Use of prescribed psychotropics during pregnancyRiaz Marakkar
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This document discusses evidence-based management of substance misuse in pregnancy. It notes that pregnant women who use substances often feel reluctant to seek support due to fears of judgment or having their baby taken away. Partnership working between health and social services is important to engage these women in a non-judgmental manner. Pregnancy can act as a catalyst for change in reducing substance use. Proper identification and management of neonatal abstinence syndrome is also important. Health professionals should provide advice and support to pregnant women around avoiding alcohol and binge drinking due to risks of fetal alcohol spectrum disorder.
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6 breastfeeding and drugs and acceptable medical reasons for artificial feedi...Varsha Shah
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The document describes an interprofessional program for caring for pregnant women with opioid dependence in rural Appalachia. The program utilizes a team approach including physicians, counselors, pharmacists, and peer recovery coaches. It provides medication-assisted treatment with buprenorphine, counseling, education, and monitoring to support successful outcomes for both mother and baby.
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
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Detoxification vs. Maintenance Treatment (methadone or buprenorphine) in Pregnancy by Jessica Young
1. Opioid Dependence in
Pregnancy: Detoxification
vs. Maintenance
Treatment
Jessica Young, MD MPH
Assistant Professor
Department of Obstetrics and Gynecology
Vanderbilt University Medical Center
3. Objectives
• We will discuss and explore the:
• prevalence of opioid use in pregnancy
• risks of chronic opioid use in pregnancy
• Treatment options
• Detoxification
• Methadone Maintenance
• Buprenorphine Maintenance
• Pregnancy management for these women
• Pain management during labor and delivery
4. A brief history of Opioids
“Presently she cast a drug into
the wine of which they drank to
lull all pain and anger and to
bring forgetfulness of every
sorrow.”
-The Odyssey, Homer, 9th
Century BC
• Sumerians cultivated
poppies ~ 300 BC
• Arab traders brought opium
to India and China ~700 AD
• Manuscripts document
addiction in Europe and
Middle East ~ 1500 AD
• Morphine isolated in 1806
• Heroin produced in 1898
and thought to have no
addictive properties.
6. Controlled Substances in TN
• The top three most prescribed controlled substances in
Tennessee in 2010 are:
• 275.5 million pills of hydrocodone (e.g., Lortab, Lorcet,
Vicodin)
• 116.6 million pills prescribed for alprazolam (e.g., Xanax:
used to treat anxiety)
• 113.5 million pills prescribed for oxycodone (e.g.,
OxyContin, Roxicodone)
• Source: Report to the 2011 107th General Assembly by the
Tennessee Department of Health Controlled Substance
Database Advisory Committee, Board of Pharmacy,
8. The Problem
• Hydrocodone/acetaminophe
n: most commonly
prescribed medication in
any category
• Misuse of prescription
analgesics increased 53%
from 1991-2002. (Blanco, et
al.)
• The misuse of opioids in
young women of
reproductive age continues
to rise.
10. Tip of the Iceberg
• Opioid abuse in Tennessee is escalating.
• 2001: 9,816 admissions for substance abuse treatment
• 762: Opiates
• 2011: 13,409 admissions for substance abuse
treatment
• 4,018: treatment of heroin or opiates
Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). The Treatment
Episode Data Set (TEDS). http://oas.samhsa.gov/dasis.htm#teds2. Accessed April 16, 2012
11. The Problem
• Substance abuse in pregnancy is common (4-16%)
• Prevalence of opioid use in pregnancy ranges from 1-
21%. (Brown, et al.)
• The incidence Neonatal Abstinence Syndrome is
increasing (1.2 to 3.39 per 1000, 2000-2009)
• Over 54,000 pregnancies in the US affected by opioid
abuse. (likely an underestimate) (NIDA)
• Opioid use in first trimester of pregnancy increased
from 8-20% over 2005-2009.
12.
13. Opioid Dependence in
pregnancy
• High risk for unplanned pregnancy
• Lack of prenatal care
• Often chaotic lifestyle with subsequent maternal
and fetal risks
• Higher incidence of abuse, incarceration,
prostitution, exposure to STDs, IV drug use, etc.
• Increased medical costs and utilization of
resources
16. Co-use of opioids and other
drugs
• Tobacco abuse is 4 times
higher compared to other
pregnant women. (Jones,Heil)
• Tobacco exacerbates other
complications of opioid use in
pregnancy.
• Alcohol abuse is seen in 14%
of women with opioid
dependence.
• Unclear what the long-term
cognitive neurobehavioral
outcomes are with concomitant
use.
17. Long-term risks to children of
opioid dependent mothers
• Sudden Infant Death Syndrome
• Higher risk for neurocognitive disorders such as
learning disabilities, ADHD and other behavioral
problems. (Hayford, Epps)
• Long-term risk of addiction
• Unknown whether this is due to opioid exposure
itself
18. Congenital anomalies and
Opioid use
• New data suggesting
association between first
trimester exposure to opioids
and congenital anomalies.
(2011 National Birth Defects
Prevention Study)
• Association with gastroschisis,
spina bifida, and heart defects
• Did not measure degree of
tobacco or ETOH use
• Important to answer this
question due to rapidly
increasing exposure during first
trimester.
19. Identification of women at
risk for substance use
Options
• Universal Screening
• Validated screening tool
• Routine UDS as part of
prenatal labs
(controversial and not
recommended without
consent)
Validated tools for
Pregnancy
• T-ACE (Tolerance, Annoyance,
Cut down, Eye-opener)
• AUDIT-C (Alcohol Use Disorders
Identification Test)
)
• TWEAK (Tolerance, Worry about
drinking, Eye-opener, Amnesia,
K/Cut down)
• TQDH (Ten Question Drinking
History)
20. Universal Screening
• 4P’s Plus Modified Screening Tool
• Parents: Did any of your parents have
a problem with alcohol or other drug
use?
• Partner: Does your partner have a
problem with alcohol or drug use?
• Past: In the past, have you had
difficulties in your life because of
alcohol or other drugs, including
prescription medications?
• Present: In the past month have you
drunk any alcohol or used other
drugs?
• Opioid abuse, dependence, and addiction in pregnancy.
Committee Opinion No. 524. American College of Obstetricians
and Gynecologists. Obstet Gynecol 2012;119:1070–6.
• First ob visit and L&D
• Eliminates provider
bias and assumptions
• Allows for early
intervention and
education
21.
22.
23. Treatment of opioid
dependent women
• Comprehensive treatment
program
• Ob, Psychiatry, Social Work,
Case Managers,
Anesthesiology
• Importance and challenge of
therapeutic alliance
• Improved outcomes for women
who receive integrated prenatal
care and substance abuse
treatment.(Goler, et al.)
• Importance of education of
ancillary staff.
24. Treatment of opioid
dependence
• Opioid maintenance is standard of care. (ACOG)
• Detoxification is often not successful with 29%
resuming use of street drugs. (outpatient setting)
• 12% opted for methadone maintenance after
detoxification.
• 25% of detox patients had withdrawal which
precipitated active labor. (Kaltenbach)
25. Opioid Detoxification
• Inpatient
• Taper with methadone or buprenorphine
(Methadone or Buprenorphine assisted
withdrawal)
• Outcomes are better for women in a residential
treatment program. (Haabrecke, 2014)
26. The obstetrical and neonatal
impact of maternal opioid
detoxification in pregnancy
• Retrospective study, AJOG 2013
• 95 women
• 53 women successfully detoxed
• 5% vs. 33% treated for withdrawal (p 0.001)
• Average LOS for success-> 25 days
• Exclusion criteria: prior unsuccessful detox, IUGR,
oligohydramnios, significant maternal psychiatric
illness
Stewart, et al;. AJOG 2013
27. Benefits of Detoxification
• Greatly reduces risk of NAS
• Theoretically reduces long-term effects of opioid
exposure
• Considered by many to be “ true recovery”
• Decreases risk of child protective services and
legal action
28. Disadvantagesof
Detoxification
• Lack of evidence based protocols
• Risk of relapse
• Shortage of drug treatment programs
• Risk of withdrawal symptoms including preterm
labor, fetal demise
• Requires large degree of financial and institutional
commitment
29. Barriers to Residential
Programs
• Lack of programs
• Cost
• Lack of insurance coverage
• Few programs allow children
• Few programs allow families
30. Methadone Maintenance
• Gold standard with decades of experience
• Increases adherence to prenatal care
• Improves pregnancy outcomes
• Decreases severity of NAS
• Decreased foster home placement
(Winklebaur et al; Kaltenback, et al.)
31. Methadone Maintenance
• For women on methadone prior to pregnancy,
continue current dosing. May need increase dose
in 3rd trimester due to increased plasma volume.
• Initiation of methadone: Start at 10-20mg and
titrate to eliminate withdrawal symptoms without
producing intoxication.
• Preferably done as inpatient
32. Methadone
disadvantages
• Daily visit to treatment center
• Cost
• Stigma
• Continued exposure to others who are using
• Incidence of NAS is still 50-66%
33. Buprenorphine maintenance
• Partial mu opioid agonist and full kappa opioid agonist
• Neonatal outcomes similar to methadone (MOTHER
trial)
• Less severe NAS with shorter hospitalization and less
morphine requirement.
• Office-based treatment
• More insurance coverage
• Feels less like being “on something.”
34. Buprenorphine Maintenance
• If on Suboxone, change to buprenorphine (Subutex).
• Little data on appropriate way to initiate buprenorphine
during pregnancy.
• Must be in moderate withdrawal which is risky in
pregnancy. Great care must be taken not to precipitate
severe withdrawal.
• Must be at least 6 hours since last dose of short-acting
opioid.
• Start with (2-4mg) and titrate for relief of withdrawal
symptoms.
35. Buprenorphine
Disadvantages
• No rigorous studies on initiation during pregnancy
• Often not effective for women using high doses of
IV opiates.
• Higher drop out rate than methadone in MOTHER
trial (33% vs. 18%) (P>0.05)
• Higher relapse rate
• Physician must obtain waiver to write rx.
36. Chronic pain in pregnancy
• Limited data
• Some studies suggest that NAS is less severe in this
population.
• 11% NAS compared to 59% in methadone
maintenance group. (Sharpe, et al.)
• Case series of women maintained on opioids for pain:
NAS 38% (Hadi, da Silva, et al)
• Treatment plans must be individualized and if tapering
is done must be done with caution.
37. Intrapartum Pain Management:
Vaginal Delivery
Methadone
• Continue current dose
• Regional anesthesia
• Avoid stadol/nubaine
• PP: Schedule NSAIDS
Buprenorphine
• d/c buprenorphine +/-
methadone OR continue
buprenorphine OR divide
dose by 25% and give q6h
• Regional anesthesia
• Avoid stadol/nubaine
• PP: Schedule NSAIDS
38. Intrapartum Pain Management:
Cesarean Delivery
Methadone
• Continue current dose
• Regional anesthesia
• Local anesthetics
• PP: NSAIDS and short-acting
opioids with
monitoring for respiratory
depression.
Buprenorphine
• Continue buprenorphine
OR d/c buprenorphine +/-
methadone OR divide
buprenorphine dose q6h.
• Regional anesthesia
• Local anesthetics
• PP: NSAIDS and short-acting
opioids
39. Intrapartum Pain Management
for Detoxed Patient
• Vaginal delivery: No change in standard of care
• Avoid Narcotics post-partum
• Cesarean Delivery: May still require increased
doses of narcotics post-op due to low pain
tolerance and high opioid tolerance.
• Important to discuss with patient her plans and
goals for post-op pain.
40. Postpartum
Considerations
• Plan for continued addiction treatment or pain
management.
• Discourage detoxification in the immediate PP
period unless in a residential program.
• High risk for PP depression.
• May get financially detoxed from methadone
treatment facility.
• Social work assistance for placement may be
needed.
41. Breastfeeding
• Breastfeeding is safe for women who are
maintained on methadone or buprenorphine and
should be supported unless contraindicated.
• Breastfeeding decreases severity of NAS.
• Promotes mother-infant bonding
• Increases maternal self-esteem.
(Abdel-Latif, et al.)
42. Vanderbilt Obstetric Drug
Dependency Clinic
• Integrated prenatal and
addiction care
• Psychiatry
• Ob
• Social Services
• Nursing
• Weekly case conference
• Weekly visits until
stabilization
• Biweekly visits
• Addiction group
• Counseling
• Serial growth scans
43. References
• Abdel-Latif ME, Pinner J, Clews S, et al. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent
moth- ers. Pediatrics 2006;117(6):e1163–9.
• Baron D; Garbely J, Boyd RL, Evaluation and Management of Substance Abuyse Emergencies Primary Psychiatry. Vulume 16, 2009
• Blanco, C., et al., Changes in the prevalence of non-medical prescription drug use and drug use disorders in the United States: 1991–1992 and 2001–
2002. Drug and Alcohol Dependence, 2007. 90(2-3): p. 252-260.
• Brown HL, B.K., Mahaffey D, Brizendine E, Hiert AK, Turnquest MA, Methadone maintenance in Pregnancy: a reappraisal. American Journal of
Obstetrics and Gynecology, 1998. 179: p. 459-63.
• Goler N, Armstrong MA, Taillac CJ, et al. Substance abuse treatment linked with prenatal visits improves perinatal outcomes: a new standard. J
Perinatol 2008;28(9): 597– 603.
• Jones HE, Heil SH, O’Grady KE, et al. Smoking in pregnant women screened for an opioid agonist medication study compared to related pregnant and
non-pregnant patient samples. Am J Drug Alcohol Abuse 2009;35(5):375– 80.
• Haabrekke KJ1, Slinning K, Walhovd KB, Wentzel-Larsen T, Moe V. The perinatal outcome of children born to women with substance
dependence detoxified in residential treatment during pregnancy. J Addict Dis. 2014;33(2):114-23. doi: 10.1080/10550887.2014.909698
• Hayford S, Epps R, Dahl-Regis M. Behavior and development patterns in children born to heroin-addicted and methadone-addicted mothers. J Natl
Med Assoc 1988; 80(11):1197–200.
• Heil SH, Jones HE, Arria A, et al. Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat 2011;40(2):199–202.
• KaltenbachK,BerghellaV,FinneganL.Opioiddependenceduringpregnancy.Effects and management. Obset Gynecol Clin North Am, 1998;25(1):139 –51.
44. References
• Kaltenbach K, Silverman N, Wapner R. Methadone maintenance during pregnancy. In: State methadone treatment guidelines, Center for Substance
Abuse Treatment 1992. Rockville (MD): US Department of Health and Human Services; 1992. p. 85–93.
• National Pregnancy and Health Survey: Drug use among women delivering live births: 1992, 1996, National Institute on Drug Abuse.
• Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). The Treatment Episode Data Set
(TEDS). http://oas.samhsa.gov/dasis.htm#teds2. Accessed April 16, 2012
• Opioid abuse, dependence, and addiction in pregnancy. Committee Opinion No. 524. American College of Obstetricians and Gynecologists. Obstet
Gynecol 2012;119:1070–6.
• Patrick SW, Schumacher RE, Benneyworth BD, Krans EE, McAllister JM, Davis MM. Neonatal abstinence syndrome and associated health care
expenditures: United States, 2000-2009 [published online April 30, 2012]. JAMA. 2012;307(18):joc1200141934-1940
• Sharpe C, Kuschel. Outcomes of infants born to mothers receiving methadone for pain management in pregnancy Arch
Dis Child Fetal Neonatal Ed 2004;89:1 F33-F36 doi:10.1136/fn.89.1.F33
• Stewart RD1, Nelson DB, Adhikari EH, McIntire DD, Roberts SW, Dashe JS, Sheffield JS. The obstetrical and neonatal impact of maternal opioid detoxification in pregnancy. Am
J Obstet Gynecol. 2013 Sep;209(3):267.e1-5. doi: 10.1016/j.ajog.2013.05.026. Epub 2013 May 29.
• Winklbaur B, Kopf N, Ebner N, et al. Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a
knowledge synthesis for better treatment for women and neonates. Addiction 2008;103:1429–40.
• Young JL, Martin PR, Treatment of Opioid Dependence in the Setting of Pregnancy. Psychiatr Clin N Am 35 (2012) 441– 460
Initially used only in religious ceremonies and along with Hemlock to put people painlessly to death. Eventually used medicinally.
Named after Morpheus “ God of dreams”
The 1900’s saw development of other opioids –each with the promise of being less addictive.
Charles Dickens, Florence Nightingale, Janis Joplin, Billie Holiday, Cory Monteith, Kurt Cobain
51 pills of hydrocodone for EVERY Tennessean above the age of 12
22 pills of alprazolam for EVERY Tennessean above the age of 12
21 pills of oxycodone for EVERY Tennessean above the age of 12
9
51 pills of hydrocodone for EVERY Tennessean above the age of 12
22 pills of alprazolam for EVERY Tennessean above the age of 12
21 pills of oxycodone for EVERY Tennessean above the age of 12
9
2005, 100 million hydrocodone/acetaminophen rx
27% of 3,403 women listed prescription opioids as their primary substance of abuse.
Tenncare database
Withdrawal symtpoms: GI hypermotility, nausea, vomiting, runny nose, piloerection, dilated pupils, shaky, jittery, abdominal cramping, body aches, hot and cold flashes
Complicating factors: Chaotic home environment, prematurity, other drug exposure
Prenatal scheduled doesn’t change: Serial growth scans
Likely needs more frequent visits due to psychiatric issues
Detox successful in only 59%
Patient must be counseled appropriately.
Infants were normally grown but had significant morbidity from prematurity.
Canada: small study: long and short-acting, normal growth parameters
Pain contract, UDS q visit, and check CSMD