Impact of maternal medication for opioid use disorder on neurodevelopmental outcomes of infants treated for neonatal opioid withdrawal syndrome

2021 ◽  
pp. 1-11
Author(s):  
R.S. King ◽  
E. Peacock-Chambers ◽  
D. Wilson ◽  
J. Shimer ◽  
S. Foss ◽  
...  
Keyword(s):  
Negative Impact ◽  
Study Groups ◽  
Opioid Use Disorder ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Opioid Use ◽  
Short Term ◽  
Neurodevelopmental Outcomes ◽  
Discharge Disposition ◽  
Secondary Outcome Variable

BACKGROUND: Increasing rates of maternal opioid use disorder has led to greater number of opioid exposed newborns (OENs). Maternal enrollment in medication for opioid use disorder (MOUD) program improves short term neonatal outcomes. This study aimed at assessing neurobehavioral outcomes for OENs. METHODS: Retrospective observational cohort study of OENs between Jul 2006 and Dec 2018. Two study groups were identified as initiation of medication for opioid use disorder (MOUD) prior to diagnoses of pregnancy or after. Primary outcome variables were enrollment in and duration of EI services. Secondary outcome variable was diagnoses of a behavioral and/or developmental disorder (BDD) during the study period. RESULTS: Of 242 infants, 113 were enrolled in EI and BDD diagnoses data was available for all infants [age range 6 to 12 years], 82% infants had exposure to maternal MOUD, while 18% were exposed to either maternal prescription non-MOUD opioids or illicit opioids. Maternal MOUD initiation prior to pregnancy was associated with improved short term outcomes for OENs. Almost a third of infants were diagnosed with a BDD with no differences between the two study groups. CONCLUSION: Early initiation of maternal MOUD improved short term outcomes and discharge disposition for OENs. Prolonged in-utero exposure to opioids presents a potential for negative impact on neurodevelopmental and behavioral outcomes. These risks must be considered to increase access and adherence to EI services, as well as to focus on non-opioid based maternal MOUD. Longitudinal studies assessing the safety of MOUD on short and long-term child health outcomes are needed.

scholarly journals LO42: A systematic review of short-term use of therapeutic opioids for children and future opioid use disorders

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S22-S22
Author(s):  
S. Ali ◽  
M. Afzalzada-Ahrari ◽  
M. Dyson ◽  
D. DaRosa ◽  
K. Dong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Opioid Use Disorder ◽  
Careful Consideration ◽  
Opioid Misuse ◽  
Opioid Use ◽  
Short Term ◽  
Cross Sectional ◽  
The Usa ◽  
The Individual

Introduction: Despite an overall decline in opioid prescriptions in Canada, healthcare visits, hospitalizations, and deaths due to opioid-related harms continue to rise for children. Clinicians urgently require high quality synthesized evidence to inform personalized decisions regarding opioid use for children. The objective of this systematic review was to examine the association between short-term therapeutic exposure to opioids and development of opioid use disorder. Methods: A medical librarian conducted a comprehensive search of 10 databases from inception to May 2019. Two authors independently assessed studies for inclusion. Studies were eligible if they reported primary research in English or French, and study participants had short (<14 days) or non-specific duration of therapeutic exposure to opioids before age 18 years. Primary outcome was the development of an opioid use disorder; secondary outcomes included opioid addiction, dependence, misuse, and abuse. Data extraction involved two independent reviewers utilizing a standardized form. Methodological quality was assessed using the NIH tools for observational studies. Results are described narratively. Results: The search identified 4,072 unique citations; 82 were selected for review, and 17 were included (3 retrospective cohort, 4 prospective cohort, and 10 cross-sectional). All studies took place in the USA. A total of 1,562,503 participants were analyzed. Nine studies were administered in schools, 3 used administrative data. While most settings were non-specific, 1 study examined opioid use in dentistry, 1 in trauma, and 1 in organized sports. One comparative study showed an association between short-term therapeutic use and opioid misuse. Two studies showed opioid related adverse events (e.g., overdose) among cohorts exposed to short-term use. The remaining 14 studies did not specify duration of exposure; therefore, confirming whether misuse was due to short-term therapeutic exposure was not possible. Conclusion: A small number of studies in this review suggest an association between short-term opioid use and opioid misuse; however, further analysis is underway with consideration of methodological limitations of the individual studies (final results pending). Careful consideration of the risk and benefits of short-term opioid use should be undertaken prior to prescribing opioids. PROSPERO Registration Number: 122681.

scholarly journals Adherence to and Retention in Medications for Opioid Use Disorder Among Adolescents and Young Adults

2020 ◽  
Author(s):  
Adam Viera ◽  
Daniel J Bromberg ◽  
Shannon Whittaker ◽  
Bryan M Refsland ◽  
Milena Stanojlović ◽  
...  
Keyword(s):  
Young Adults ◽  
Opioid Use Disorder ◽  
Adolescents And Young Adults ◽  
Outcome Variable ◽  
Opioid Use ◽  
Younger Age ◽  
Full Text Review ◽  
The Individual ◽  
Negative Health Outcomes

Abstract The volatile opioid epidemic is associated with higher levels of opioid use disorder (OUD) and negative health outcomes in adolescents and young adults. Medications for opioid use disorder (MOUD) demonstrate the best evidence for treating OUD. Adherence to and retention in MOUD, defined as continuous engagement in treatment, among adolescents and young adults, however, is incompletely understood. We examined the state of the literature regarding the association of age with adherence to and retention in MOUD using methadone, buprenorphine, or naltrexone among persons aged 10–24 years, along with related facilitators and barriers. All studies of MOUD were searched for that examined adherence, retention, or related concepts as an outcome variable and included adolescents or young adults. Search criteria generated 10,229 records; after removing duplicates and screening titles and abstracts, 587 studies were identified for full-text review. Ultimately, 52 articles met inclusion criteria for abstraction and 17 were selected for qualitative coding and analysis. Younger age was consistently associated with shorter retention, although the overall quality of included studies was low. Several factors at the individual, interpersonal, and institutional levels, such as concurrent substance use, MOUD adherence, family conflict, and MOUD dosage and flexibility, appeared to have roles in MOUD retention among adolescents and young adults. Ways MOUD providers can tailor treatment to increase retention of adolescents and young adults are highlighted, as is the need for more research explaining MOUD adherence and retention disparities in this age group.

scholarly journals Summated Hazard Score as a Powerful Predictor of Fatigue in Relation to Pacing Strategy

2021 ◽  
Vol 18 (4) ◽  
pp. 1984
Author(s):  
Sylvia Binkley ◽  
Carl Foster ◽  
Cristina Cortis ◽  
Jos J. de Koning ◽  
Christopher Dodge ◽  
...  
Keyword(s):  
Perceived Exertion ◽  
Time Trial ◽  
Rating Of Perceived Exertion ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Start Time ◽  
Slow Start ◽  
Pacing Strategy ◽  
Secondary Outcome Variable ◽  
Fast Start

During competitive events, the pacing strategy depends upon how an athlete feels at a specific moment and the distance remaining. It may be expressed as the Hazard Score (HS) with momentary HS being shown to provide a measure of the likelihood of changing power output (PO) within an event and summated HS as a marker of how difficult an event is likely to be perceived to be. This study aimed to manipulate time trial (TT) starting strategies to establish whether the summated HS, as opposed to momentary HS, will improve understanding of performance during a simulated cycling competition. Seven subjects (peak PO: 286 ± 49.7 W) performed two practice 10-km cycling TTs followed by three 10-km TTs with imposed PO (±5% of mean PO achieved during second practice TT and a self-paced TT). PO, rating of perceived exertion (RPE), lactate, heart rate (HR), HS, summated HS, session RPE (sRPE) were collected. Finishing time and mean PO for self-paced (time: 17.51 ± 1.41 min; PO: 234 ± 62.6 W), fast-start (time: 17.72 ± 1.87 min; PO: 230 ± 62.0 W), and slow-start (time: 17.77 ± 1.74 min; PO: 230 ± 62.7) TT were not different. There was a significant interaction between each secondary outcome variable (PO, RPE, lactate, HR, HS, and summated HS) for starting strategy and distance. The evolution of HS reflected the imposed starting strategy, with a reduction in PO following a fast-start, an increased PO following a slow-start with similar HS during the last part of all TTs. The summated HS was strongly correlated with the sRPE of the TTs (r = 0.88). The summated HS was higher with a fast start, indicating greater effort, with limited time advantage. Thus, the HS appears to regulate both PO within a TT, but also the overall impression of the difficulty of a TT.

Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms?

2021 ◽  
pp. medethics-2020-107160
Author(s):  
John C Messinger ◽  
Daniel J Ikeda ◽  
Ameet Sarpatwari
Keyword(s):  
Civil Commitment ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Short Term ◽  
Community Based ◽  
Loss Of Life ◽  
Severe Withdrawal ◽  
The Usa ◽  
Overdose Deaths

In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment—the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.

scholarly journals Prescription Opioid Use Among Populations of Reproductive Age: Effects on Fertility, Pregnancy Loss, and Pregnancy Complications

2020 ◽  
Author(s):  
Kerry S Flannagan ◽  
Lindsey A Sjaarda ◽  
Sunni L Mumford ◽  
Enrique F Schisterman
Keyword(s):  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Pregnancy Loss ◽  
Opioid Use Disorder ◽  
Reproductive Age ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Short Term ◽  
Prescription Opioid Use ◽  
The Impact

Abstract Prescription opioid use is common among men and women of reproductive age, including during assisted-reproduction procedures. Opioid use disorder and chronic use are associated with harms to fertility and pregnancy outcomes, but it is unclear whether these associations extend to common short-term patterns of prescription opioid use. We conducted a literature review using PubMed, Embase, Web of Science, and Scopus to identify studies of nonchronic, nondependent opioid use and reproductive endpoints including fertility, pregnancy loss, and pregnancy complications (i.e., preterm birth, birth weight, gestational diabetes, and hypertensive disorders of pregnancy). Seventeen studies were included. Although results of the studies suggest possible harms of short-term opioid use on fertility and pregnancy loss, methodologic limitations and the small number of studies make the literature inconclusive. This review highlights important data gaps that must be addressed to make conclusions about potential reproductive effects of short-term opioid use. These include the need for additional data on opioid use before clinically recognized pregnancy; accurate measurement of opioid exposure by multiple means with detailed information on the types and quantity of opioids used; assessment of important confounders, including opioid use indication, comorbidities, and use of other medications and substances; and studies of paternal opioid use, fertility, and pregnancy outcomes. A primary limitation of this review targeting studies of nonchronic opioid exposure is the possibility that selected studies included populations with unspecified chronic or dependent opioid use. Efforts to understand the impact of the prescription opioid epidemic should address potential reproductive harms of these medications among people of reproductive age.

Efficacy of Fosphenytoin as First-Line Antiseizure Medication for Neonatal Seizures Compared to Phenobarbital

2020 ◽  
Vol 36 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Veronica Alix ◽  
Mansi James ◽  
Anthony H. Jackson ◽  
Paul F. Visintainer ◽  
Rachana Singh
Keyword(s):  
Negative Impact ◽  
Study Groups ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
First Line ◽  
Neurodevelopmental Outcomes ◽  
Treatment Protocols ◽  
Neurodevelopmental Delay ◽  
Observational Cohort

Currently used treatment protocols for neonatal seizures vary among centers with limited evidence to support the choice of a given antiseizure medication. Because of concerns about the potential negative impact of phenobarbital on long-term neurodevelopment outcomes, our unit transitioned to fosphenytoin as the first-line antiseizure medication. A retrospective observational cohort study was conducted to compare the acute and long-term outcomes of fosphenytoin and phenobarbital as first-line antiseizure medication for neonatal seizure treatment. The 2 study groups had similar baseline characteristics for neonatal variables as well as maternal antenatal complications. We did not find any differences in the acute outcomes between the 2 groups. However, significantly fewer infants in the fosphenytoin group had moderate-to-severe neurodevelopmental delay at the 18- and 24-month assessments. In conclusion, although both medications were equally efficacious for acute neonatal seizure control, fosphenytoin had the potential for significantly better neurodevelopmental outcomes at 18-24 months of age.

scholarly journals Opioid Replacement for Pregnant Mothers With Opioid Use Disorder and Fetal Neurodevelopment: A Review

2017 ◽  
Vol 7 (2) ◽  
pp. 70-74
Author(s):  
Caragh Dallas Miller ◽  
Elizabeth Nizalik ◽  
David Grynspan
Keyword(s):  
Experimental Data ◽  
Multidisciplinary Care ◽  
In Utero ◽  
Opioid Use Disorder ◽  
Long Term Effects ◽  
Opioid Use ◽  
Neurodevelopmental Outcomes ◽  
Skin Contact ◽  
Language Communication ◽  
Multigenerational Effects

This paper reviews the published literature regarding neurodevelopmental outcomes in neonates following in utero exposure to opioids. We have summarized available clinical and experimental data. Overall, clinical data is limited and equivocal with most studies showing no significant neurodevelopmental impairments in infants and children exposed to opioids in utero. Various outcome measures assessed language, communication, cognitive, psychomotor, and behavioural outcomes. The equivocality of the data may be a result of the complexity of the cohort and the inability to disentangle the effect of the opioids from the multiple comorbidities. Results from experimental data show that all opioids cross the placental barrier. Mouse studies show biochemical and neurophysiological changes, leading to long-term effects on learning and memory. Some data also suggests that epigenetic and imprinting changes in the central nervous system of mice may lead to multigenerational effects of opioid exposure. Ultimately, the benefits of opioid replacement therapy outweigh its risks, but it should be done in the context of a broader biopsychosocial risk reduction approach. Promoting mother-child bonding and care through skin-to-skin contact, rooming-in, and breastfeeding can reduce severity of neonatal abstinence syndrome and improve outcomes. This cohort of women and children requires advocacy for comprehensive multidisciplinary care. RésuméCet article passe en revue la littérature publiée concernant les résultats neurodéveloppementaux chez les nouveau-nés après exposition in utero aux opioïdes. Nous avons résumé les données cliniques et expérimentales disponibles. Dans l’ensemble, les don- nées cliniques sont limitées et équivoques, avec la plupart des études ne montrant aucune déficience neurodéveloppementale significative chez les nourrissons et les enfants exposés aux opioïdes in utero. Diverses mesures de résultats ont évalué les résultats linguistiques, de communication, cognitifs, psychomoteurs et comportementaux. L’équivocité des données peut être le résultat de la complexité de la cohorte et de l’incapacité à démêler l’effet des opioïdes des multiples comorbidités. Les résultats des données expérimentales montrent que tous les opioïdes traversent la barrière placentaire. Les études sur la souris montrent des changements biochimiques et neurophysiologiques, conduisant à des effets à long terme sur l’apprentissage et la mémoire. Certaines données suggèrent également que les changements épigénétiques et d’empreinte dans le système nerveux central des souris peuvent conduire à des effets multigénérationnels de l’exposition aux opioïdes. En fin de compte, les avantages de la thérapie de substitution aux opioïdes l’emportent sur ses risques, mais cela devrait être fait dans le contexte d’une approche plus large de réduction des risques biopsychosociaux. La promotion des liens et des soins entre la mère et l’enfant par le contact peau à peau, l’accoutumance et l’allaitement peut réduire la gravité du syndrome d’abstinence néonatale et améliorer les résultats. Cette cohorte de femmes et d’enfants a besoin de plaidoyer pour des soins multidisciplinaires complets. 

scholarly journals Betulin-Based Oleogel to Improve Wound Healing in Dystrophic Epidermolysis Bullosa: A Prospective Controlled Proof-of-Concept Study

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Agnes Schwieger-Briel ◽  
Dimitra Kiritsi ◽  
Christoph Schempp ◽  
Cristina Has ◽  
Hauke Schumann
Keyword(s):  
Wound Healing ◽  
Epidermolysis Bullosa ◽  
Statistical Significance ◽  
Treatment Options ◽  
Pilot Trial ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Birch Bark ◽  
Accelerate Wound Healing ◽  
Secondary Outcome Variable

Introduction. Skin fragility and recurrent wounds are hallmarks of hereditary epidermolysis bullosa (EB). Treatment options to accelerate wound healing are urgently needed. Oleogel-S10 contains a betulin-rich triterpene extract from birch bark. In this study, we tested the wound healing properties of topical Oleogel-S10 in patients with dystrophic EB. Methods. We conducted an open, blindly evaluated, controlled, prospective phase II pilot trial in patients with dystrophic EB (EudraCT number 2010-019945-24). Healing of wounds treated with and without topical Oleogel-S10 was compared. Primary efficacy variable was faster reepithelialization as determined by 2 blinded experts. The main secondary outcome variable of the study was percentage of wound epithelialization. Results. Twelve wound pairs of 10 patients with dystrophic EB were evaluated. In 5 of 12 cases, both blinded reviewers considered epithelialization of the intervention wounds as superior. In 3 cases, only one reviewer considered Oleogel-S10 as superior and the other one as equal to control. Measurements of wound size showed a trend towards accelerated wound healing with the intervention but without reaching statistical significance. Conclusion. Our results indicate a potential for faster reepithelialization of wounds in patients with dystrophic EB when treated with Oleogel-S10 but larger studies are needed to confirm significance.

scholarly journals Adults With Opioid and Methamphetamine Co-use Have Lower Odds of Completing Short-Term Residential Treatment Than Other Opioid Co-use Groups: A Retrospective Health Services Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Orrin D. Ware ◽  
Jennifer I. Manuel ◽  
Andrew S. Huhn
Keyword(s):  
Logistic Regression ◽  
Residential Treatment ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Opioid Use Disorder ◽  
Treatment Retention ◽  
Residential Setting ◽  
Treatment Episode ◽  
Opioid Use ◽  
Short Term

Objective: There is an increase in persons entering substance use treatment who co-use opioids and methamphetamines in recent years. Co-using these substances may negatively impact treatment retention in the residential setting. We explored predictors of adults completing short-term residential treatment among persons with primary opioid use disorder (OUD) who co-use either alcohol, benzodiazepines, cocaine, or methamphetamines.Methods: This study used the 2019 de-identified, publicly available Treatment Episode Dataset-Discharges. The sample included adults discharged from short-term residential treatment with primary OUD who co-used either alcohol, benzodiazepines, cocaine, or methamphetamines. The final sample size included 24,120 treatment episodes. Univariate statistics were used to describe the sample. Two logistic regression models were used to predict completing treatment. The first logistic regression model included the co-use groups as predictors and the second model added other demographic and treatment-relevant covariates.Results: A slight majority (51.4%) of the sample prematurely discharged from treatment. Compared to the other three co-use groups, the opioid and methamphetamine co-use group had the highest proportion of individuals who were women (45.0%), unemployed (62.5%), current injection drug use (76.0%), living in the Midwest (35.9%), living in the south (33.5%), and living in the west (15.5%). The opioid and methamphetamine co-use group also had the highest proportion of individuals not receiving medications for OUD (84.9%), not having a prior treatment episode (28.7%), and not completing treatment (57.4%). In the final logistic regression model, which included covariates, the opioid and alcohol (OR = 1.18, 95% CI = 1.080–1.287, p &lt; 0.001), opioid and benzodiazepine (OR = 1.33, 95% CI = 1.213–1.455, p &lt; 0.001), and opioid and cocaine (OR = 1.16, 95% CI = 1.075–1.240, p &lt; 0.001) co-use groups had higher odds of completing treatment than the opioid and methamphetamine co-use group.Conclusions: Opioid and methamphetamine co-use may complicate short-term residential treatment retention. Future work should identify effective strategies to retain persons who co-use opioids and methamphetamines in treatment.

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