scholarly journals Opioid Use Disorder and Opioid Maintenance Therapy: Considerations for Perinatal Care and Breastfeeding (2019/068)

2019 ◽  
Vol 64 (5) ◽  
pp. 681-682
Keyword(s):  
Maintenance Therapy ◽  
Perinatal Care ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Maintenance Therapy

Does Opioid Maintenance Therapy Decrease the Risk of Neonatal Withdrawal in Mothers with Opioid Use Disorder? [28N]

2018 ◽  
Vol 131 ◽  
pp. 159S
Author(s):  
Victoria Ly ◽  
Malini D. Persad ◽  
Kimberly Herrera ◽  
David Garry ◽  
Diana Garretto
Keyword(s):  
Maintenance Therapy ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Maintenance Therapy ◽  
Neonatal Withdrawal

scholarly journals Opioids and the developing brain: time to rethink perinatal care for infants of opioid-dependent mothers

2021 ◽  
pp. fetalneonatal-2020-320102
Author(s):  
James P Boardman ◽  
Helen Mactier ◽  
Lori A Devlin
Keyword(s):  
Perinatal Care ◽  
Opioid Use Disorder ◽  
Visual Development ◽  
Opioid Use ◽  
Health Crisis ◽  
Long Term Follow Up ◽  
And Function ◽  
Opioid Withdrawal Syndrome ◽  
Infant Brain Development

Illicit use of opioids is a global health crisis with major implications for women and children. Strategies for managing opioid use disorder (OUD) in pregnancy have been tested over the past 40 years, but studies have focused on maternal and pregnancy outcomes, with less attention given to long-term follow-up of exposed children. Here, we provide a narrative review of recent advances in the assessment and management of neonatal opioid withdrawal syndrome (NOWS), and we summarise evidence from multiple domains—neuroimaging, electrophysiology, visual development and function, neurodevelopment, behaviour, cognition and education—which suggests that prenatal opioid exposure modifies child development. Further studies are required to determine the optimal management of pregnant women with OUD and babies with NOWS. We identify knowledge gaps and suggest that future study designs should evaluate childhood outcomes, including infant brain development and long-term neurocognitive and visual function.

Keeping Up with Clinical Advances: Opioid Use Disorder

CNS Spectrums ◽  
2019 ◽  
Vol 24 (S1) ◽  
pp. 14-24 ◽  
Author(s):  
Biren Patel ◽  
Thomas R. Kosten
Keyword(s):  
Maintenance Therapy ◽  
Patient Outcomes ◽  
Opioid Use Disorder ◽  
Affective States ◽  
Adherence To Treatment ◽  
Opioid Use ◽  
Negative Affective States ◽  
Overdose Deaths ◽  
Clinical Advances ◽  
Improve Patient

Opioid use disorder (OUD) is a disorder that can lead to several negative outcomes, including overdose and death. A variety of opioids can be abused by individuals including both prescribed and non-prescribed opioids. Continued opioid use can be driven by negative affective states associated with opioid withdrawal. Several treatments exist in the field including medication assisted treatments such as methadone, buprenorphine, and naltrexone. Treatments such as clonidine and lofexidine can also be used to assist with decreasing withdrawal symptoms. Increasing adherence to treatment can further improve patient outcomes and promote continuation with treatment. A variety of methods to reduce relapse can also be utilized such as opioid agonists and maintenance therapy. According to the Centers for Disease Control, opioid overdoses contributed to 67.8% of overdose deaths in 2017.

scholarly journals Addressing opioid use disorder among rural pregnant and postpartum women: a study protocol

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
M. Aryana Bryan ◽  
Marcela C. Smid ◽  
Melissa Cheng ◽  
Katherine T. Fortenberry ◽  
Amy Kenney ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Study Protocol ◽  
Repeated Measures ◽  
Perinatal Care ◽  
The United States ◽  
Opioid Use Disorder ◽  
Rural Setting ◽  
Evidence Based ◽  
Provider Education ◽  
Opioid Use

Abstract Background Opioid use disorder (OUD) among women delivering at a hospital has increased 400% from 1999–2014 in the United States. From the years 2007 to 2016, opioid-related mortality during pregnancy increased over 200%, and drug-overdose deaths made up nearly 10% of all pregnancy-associated mortality in 2016 in the US. Disproportionately higher rates of neonatal opioid withdrawal syndrome (NOWS) have been reported in rural areas of the country, suggesting that perinatal OUD is a pressing issue among these communities. There is an urgent need for comprehensive, evidence-based treatment services for pregnant women experiencing OUD. The purpose of this article is to describe a study protocol aimed at developing and evaluating a perinatal OUD curriculum, enhancing evidence-based perinatal OUD treatment in a rural setting, and evaluating the implementation of such collaborative care for perinatal OUD. Methods This two-year study employed a one group, repeated measures, hybrid type-1 effectiveness-implementation design. This study delivered interventions at 2 levels, both targeting improvement of care for pregnant women with OUD. The first area of focus was at the community healthcare provider-level, which aimed to evaluate the acceptability and feasibility of perinatal OUD education across time and to improve provider education by increasing knowledge specific to: MOUD provision; screening, brief intervention, and referral to treatment (SBIRT) utilization; and NOWS treatment. The second area of intervention focus was at the patient-level, which assessed the preliminary effect of perinatal OUD provider education in promoting illicit opioid abstinence and treatment engagement among pregnant women with OUD. We adopted constructs from the Consolidated Framework for Implementation Research (CFIR) to assess contextual factors that may influence implementation, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) model to comprehensively evaluate implementation outcomes. Discussion This article presents the protocol of an implementation study that is employing the CFIR and RE-AIM frameworks to implement and evaluate a perinatal OUD education and service coordination program in two rural counties. This protocol could serve as a model for clinicians and researchers seeking to implement improvements in perinatal care for women with OUD in other rural communities. Trial registration NCT04448015 clinicaltrials.gov.

scholarly journals Infectious Disease (ID) Learning Unit: What the ID Clinician Needs to Know About Buprenorphine Treatment for Opioid Use Disorder

2016 ◽  
Vol 4 (1) ◽  
Author(s):  
Amanda A. Westlake ◽  
Mark P. Eisenberg
Keyword(s):  
Infectious Disease ◽  
Drug Use ◽  
Maintenance Therapy ◽  
Injection Drug Use ◽  
Infectious Complications ◽  
Opioid Use Disorder ◽  
Clinical Use ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Buprenorphine Treatment

Abstract In the context of an escalating opioid epidemic, infectious disease clinicians increasingly treat the infectious complications of injection drug use. In this learning unit, we review the history, pharmacology, and clinical use of buprenorphine as maintenance therapy for opioid use disorder, and we describe the process by which clinicians can obtain a buprenorphine waiver.

scholarly journals Harm Reduction Service Utilization Among People Who Inject Drugs in Tajikistan: Prevalence and Precipitating Factors

2020 ◽  
Author(s):  
Mary M. Tate ◽  
Daniel J. Bromberg ◽  
Kamiar Alaei ◽  
Saifuddin Karimov ◽  
Dilshod Saidi ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Harm Reduction ◽  
People Who Inject Drugs ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Methadone Maintenance Therapy ◽  
People Who Use Drugs ◽  
People Living With Hiv ◽  
Opioid Use ◽  
Needle And Syringe Programs

Abstract Tajikistan is in a unique geopolitical location along the global heroin trade route, exacerbating its own opioid use disorder and HIV epidemics. With one of the highest rates of opioid use disorder in the world, and 20,000-30,000 people who inject drugs in the country, Tajikistan’s government and international actors have provided harm reduction measures for people who use drugs, like narcology centers, needle and syringe programs, and methadone maintenance therapy. No implementation science studies have been conducted in Tajikistan and the current implementation gaps in service uptake are unknown. The purpose of this paper is to determine the prevalence of harm reduction service uptake among people who use drugs in Tajikistan, and determine which factors are associated with service uptake. Methods This paper uses data from the National AIDS Registry, subset to patients who use drugs (n=11,029) and cross-sectional data from a bio-behavioral survey conducted in 2017 (n=2,390). Univariate and multivariate logistic regression were used to assess associations between study variables and probably of uptake of narcology center registration, uptake of needle and syringe programs, and registration into methadone maintenance therapy. Results Fewer than half of all people who inject drugs (42.4%) were registered with the narcology center , most people who inject drugs (88.6%) reported always having access to clean syringes, and only 5.3% of PWID had ever engaged in methadone treatment in Tajikistan. There were ethnic differences in service uptake – with ethnic Russians and Uzbeks less likely to use services than ethnic Tajiks. Men who have sex with men and people living with HIV were also more likely to access services than heterosexual or seronegative individuals. Conclusion Narcology center registration and clean needle coverage are high in Tajikistan. Methadone maintenance therapy uptake, however, is low, like in other countries in Eastern Europe and Central Asia. NGO and government initiatives that target risk groups (like LGBTQ+ people and people living with HIV) seem to have been somewhat effective at recruiting their clientele into services. Future research might focus on the “positive deviancy” of these subgroups of people who use drugs to learn how to increase service uptake generally.

Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

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