Methadone-maintained Women Research Articles

A Randomized Controlled Trial of Brief Cognitive Behavioral Therapy for Regular Methamphetamine Use in Methadone Treatment

ABSTRACTThis study evaluated the efficacy of brief cognitive behavioral therapy (BCBT) for regular methamphetamine use among methadone-maintained women. A randomized controlled trial was conducted in four methadone treatment services. Eligible women were assigned to receive either BCBT or drug education. Five questionnaires were used to assess the research hypotheses at weeks 0, 4, and 12. Urinalysis was used to verify self-reported methamphetamine use at week 0. Urinalyses were used for those participants who reported abstinence from methamphetamine at weeks 4 and 12. Overall, 120 women were enrolled. Sixteen participants were lost to follow-up. Compared with the control group, the treatment group showed significant reductions in frequency of methamphetamine use (p < 0.001), severity of methamphetamine dependence (p < 0.001), and number of days of methamphetamine use (p < 0.001) at weeks 4 and 12. Significant improvements in readiness to change (p < 0.001), psychological well-being (p < 0.001), and social functioning (p = 0.001) were found in the treatment group at weeks 4 and 12. Nineteen urine specimens (31.66%) in the treatment group were negative for methamphetamine use at post-treatment and follow-up, while no change was found in the control group (0.00%). The study supported the efficacy of BCBT for methamphetamine use and associated harms.

Opioid Use among Women on a Stable Methadone Dose

Background: Opioid use on a stable methadone dose is a health concern in Iran, the most populous Persian Gulf country. However, the underlying reasons associated with opioid use have not been studied. Objectives: The study aimed to explore the reasons associated with opioid use among a group of Persian methadone-maintained women. The other aim was to explore effective interventions to stop this problem. Methods: The current qualitative study was conducted between June 2008 and December 2009. The study sites included ten large methadone treatment clinics in Tehran. The study employed semi-structured interviews with 50 women. Six roundtable meetings were conducted with nine key informants. NVivo 10 was used to thematically analyze the data. Results: Women were on a stable methadone dose of 45 - 115 mg for at least six months. Opioid availability, an opioid-dependent lifestyle, peer pressure and self-treatment were the reasons of opioid use. The provision of cognitive-behavioral therapy, life skills, observational learning, and mental health services were the suggested interventions to stop opioid use. Conclusions: Opioid use on a stable methadone dose had been facilitated by some factors which should be considered in methadone treatment. The suggested interventions should be considered in increasing methadone treatment outcomes.

Methamphetamine Use Disorder Untreated among Women in Methadone Treatment in Iran

Background: Methamphetamine (MA) use disorder is a new health problem among female methadone patients in Iran. Some characteristics of women are likely to be associated with poor methadone treatment outcomes. However, there are few studies about the characteristics of this group. Objectives: The current study is the first research that aimed to investigate the demographic, drug use and treatment characteristics of a group of regular MA-using women in methadone treatment. Methods: Methadone-maintained women who reported at least weekly MA use were recruited from four methadone treatment centres in Tehran. Participants’ drug use, severity of MA dependence, psychiatric distress, social functioning, criminality and high risk sexual behaviours were measured among the participants. Urinalysis was done to confirm MA use. Results: Between 28 July 2014 and 15 May 2015, 120 participants completed an interview. Mean duration of MA use was 5.4 (SD 2.1) years. Only 9.2% of the participants reported prior MA treatment. Psychiatric distress was high among all participants. Overall, 61 participants (50.8%) reported long duration of MA use (i.e. five years or more) while 59 participants (49.2%) reported less than five years of MA use. Severity of MA dependence (P = 0.38), psychiatric distress (P = 0.36), social functioning (P = 0.12) and criminality (P = 0.82) were not significantly associated with duration of MA use. However, participants who reported long duration of MA use were more likely to be engaged in high risk sexual behaviours (P = 0.01) compared with those reporting short duration of MA use. Conclusions: The study results indicated that participants had multiple health problems. High risk sexual behaviours were considerable among participants with long duration of MA use despite being in methadone treatment. Participants had little or no previous treatment for MA use disorder. Treatment services should be expanded to address MA use disorder and its harms among this group.

Brief Cognitive-Behavioural Therapy for Methamphetamine Use among Methadone-Maintained Women: A Multicentre Randomised Controlled Trial

Objective: Addressing co-existing methamphetamine (MA) use disorder in methadone treatment services can improve treatment adherence and outcomes. This study aimed to assess the feasibility and efficacy of brief cognitive-behavioural therapy (BCBT) on MA use disorder among a group of methadone-maintained women. Methods: In this multicentre randomised controlled trial, women who had been stabilised on at least three months of methadone treatment and reported at least weekly MA use were enrolled from four methadone treatment centres in Iran and randomly assigned (1:1) to receive either BCBT or standard drug information for four weeks. The primary outcome was self-reported number of days of MA use over the treatment period. Outcomes were assessed at weeks 0, 4 and 12. Urinalysis was used to confirm self-reported abstinence from MA at weeks 4 and 12. Results: Overall, 120 women were enrolled and randomised; 60 were assigned to the BCBT group and 60 to the control group. Only 16 women were lost to 12 week follow-up. The BCBT group had significant reductions in number of days of MA use, quantity/frequency of MA use and severity of MA dependence at week four. MA use reduction was accompanied with significant improvements in readiness to change MA use, psychological well-being and social functioning following intention-to-treat analysis. All results remained significant at 12 week follow-up. Conclusion: The study results supported the feasibility and efficacy of BCBT in reducing MA use disorder and improving the health and social contexts of the participants. The findings of this study may assist methadone treatment providers to better understand the role of BCBT for co-existing MA use disorder among women in methadone treatment services.

Obstetrical and neonatal outcomes of methadone-maintained pregnant women: a canadian multisite cohort study.

To describe obstetrical and neonatal outcomes including neonatal abstinence syndrome (NAS) in a Canadian cohort of methadone-maintained pregnant women. We conducted a retrospective chart review at three integrated care programs in Vancouver, Toronto, and Montreal. Pregnant women on methadone maintenance treatment (MMT) who attended for care between 1997 and 2009 were included in this multisite study. Maternal and neonatal outcomes in each of the three contributing centres were compared. A total of 94 pregnant methadone-maintained women were included in the final analysis: 36 from Toronto, 36 from Vancouver, and 22 from Montreal. Maternal demographics showed inter-site differences in ethnicity and marital status. Obstetrical complications were not frequent; the most frequent was antenatal hemorrhage, which occurred in 14% of the total cohort. The incidence of premature labour was significantly higher in Vancouver and Montreal than in Toronto. The mean gestational age at delivery for the entire cohort was 38 weeks; mean birth weight was 2856 grams. The average length of hospital stay for babies with NAS was 19 days, with 27% of neonates requiring pharmacological treatment for NAS. Approximately 60% of neonates were discharged from hospital to the care of their mother. Integrated care programs resulted in satisfactory obstetrical and neonatal outcomes for pregnant women on MMT. Policies promoting maternal-newborn contact, rooming-in, and breastfeeding may help to decrease the severity of NAS and the need for pharmacological treatment of NAS. We strongly recommend the development of similar programs across Canada to address gaps in services.

Characteristics and quality of life of opioid-dependent pregnant women in Austria.

This study investigated pregnant opioid-dependent women undergoing maintenance therapy, applying a multidisciplinary, case-management approach at the Addiction Clinic of the Medical University of Vienna, Austria. It aimed at characterizing the patients' basic demographic and clinical parameters and evaluating their overall quality of life (QoL) prepartum and postpartum. Three hundred ninety women were treated between 1994 and 2009 with buprenorphine (n = 77), methadone (n = 184), or slow-release oral morphine (SROM) (n = 129) on an outpatient basis throughout their pregnancy and postpartum period. All patients were subject to standardized prepartum and postpartum medical and psychiatric assessments, including QoL assessments using a German adaptation of the Lancashire QoL Profile (Berliner Lebensqualitaetsprofil), and regular supervised urine toxicologies. No medication group differences were revealed regarding basic demographic or clinical data. Mean maintenance doses (SD) at time of delivery were as follows: 64 mg (36 mg) methadone, 10 mg (6 mg) buprenorphine, 455 mg (207 mg) SROM. However, buprenorphine-medicated women showed significantly less concomitant benzodiazepine consumption than methadone- or SROM-maintained women (p = 0.005), and significantly less concomitant opioid consumption than methadone-maintained women (p = 0.033) during the last trimester. Overall QoL was good prepartum and postpartum in all measured domains except "finances" and "prospect of staying in the same housing situation," and no differences were observed in QoL among the three medication groups (p = 0.177). QoL improved significantly after delivery in most of the domains (p < 0.001). Although opioid-dependent pregnant women face high-risk pregnancies and show variability in addiction severity, they report good QoL independent of the medication administered. These results show that individually tailored treatment interventions are effective for this patient population and suggest a QoL improvement after delivery.

Psychosocial characteristics and poly-drug use of pregnant women enrolled in methadone maintenance treatment

Pregnant women with substance dependency are a high-risk psychiatric and obstetric population, with their infants also at elevated neonatal risk. This paper draws on prospective, longitudinal data from a regional cohort of 81 methadone-maintained (MM) and 107 comparison women and their infants to describe the obstetric, socio-familial and mental health needs of women in methadone maintenance treatment during pregnancy. Of particular interest was the extent and pattern of maternal licit and illicit drug use over the course of pregnancy. Results showed that MM women had complex reproductive histories, chronic health problems, and were subject to high rates of socioeconomic adversity and comorbid mental health problems. During pregnancy, more than half continued to use licit and illicit drugs, although there was a general trend for drug use to reduce over time. No differences were observed between women maintained on low (12.5–61.0mg/day) and high (61.1–195.0mg/day) doses of methadone, with the exception of opiate abuse which was higher in the low dose group (p=.07). Findings highlight that pregnant women enrolled in MMT and their infants represent a vulnerable group with complex, social, obstetric and psychiatric needs. They also reinforce the need for services that can provide on-going wrap-around, multidisciplinary and multiagency care for these high risk dyads, both during pregnancy and in the transition to parenthood.

Patterns of Symptom Reporting During Pregnancy Comparing Opioid Maintained and Control Women

To characterize the range of symptoms experienced by pregnant methadone-maintained (MM) and buprenorphine-maintained (BM) women to determine whether these differ from those experienced by a control group of nonopioid exposed pregnant women. Opioid-maintained (OM) patients report high rates of symptoms related to direct opioid effects and withdrawal. Pregnancy is associated with a range of symptoms, some overlapping with opioid effects and withdrawal. Prospective, nonrandomized, open-label comparison study undertaken in a large teaching maternity hospital in South Australia. Pregnant BM (n = 25), MM (n = 25) and nonopioid exposed controls (n = 25) were recruited and matched for age, parity, gravidity, alcohol consumption, and smoking status. Symptom report patterns, maternal withdrawal, and additional substance use were assessed. MM women reported 10 and BM women reported 2 symptoms throughout pregnancy at rates greater than controls. Methadone-maintained women reported significantly (P < 0.05) more symptoms than BM women compared to controls throughout pregnancy. Methadone-maintained women reported 8 and BM women reported 3 symptoms in the third trimester at rates greater than controls. Methadone-maintained women reported greater opioid withdrawal than controls; this did not occur in BM women. Additional substance use was comparable between BM and MM women but greater than controls. Patterns of symptom reports may have clinical implications for maternal and fetal health during pregnancy for OM women including optimization of opioid dosing regimens, education regarding maternal nutritional intake and preventing postnatal depression, thereby ensuring maternal health and fetal development during pregnancy and enhancing mother-infant bonding and healthy child development postnatally.

Breastfeeding Considerations of Opioid Dependent Mothers and Infants

The American Academy of Pediatrics (AAP) has a long-standing recommendation against breastfeeding if the maternal methadone dose is above 20 mg/day. In 2001, the AAP lifted the dose restriction of maternal methadone allowing methadone-maintained mothers to breastfeed. The allowance of breastfeeding among mothers taking methadone has been met with opposition due to the uncertainty that exists related to methadone exposure of the suckling infant. Methadone-maintained mothers are at higher risk for abuse, concomitant psychiatric disorders, limited access to healthcare, and financial hardship. Breastfeeding rates among methadone-maintained women tend to be low compared to the national average. This manuscript will discuss the implications for healthcare practitioners caring for methadone-maintained mothers and infants and associated risks and benefits of breastfeeding. This population of mothers and infants stands to obtain particular benefits from the various well-known advantages of breastfeeding.

Contingent incentives reduce cigarette smoking among pregnant, methadone-maintained women: results of an initial feasibility and efficacy randomized clinical trial.

This study examined the feasibility and efficacy of behavioral incentives for reducing cigarette smoking among pregnant methadone-maintained patients. Participants (n = 102) were assigned randomly to: (i) contingent behavioral incentives (CBI: n = 42); (ii) non-contingent behavioral incentives (NCBI: n = 28); or (iii) treatment as usual (TAU: n = 32). Study procedures were implemented at the Center for Addiction and Pregnancy in Baltimore, MD. Study participants were pregnant, methadone-maintained women enrolled in substance use disorder treatment. Baseline carbon monoxide (CO) levels were calculated for each participant. Subsequently, breath samples were tested three times weekly to measure changes in smoking behavior. CBI participants received incentives for target reductions from baseline: any reduction (week 1); 10% reduction (weeks 2-4), 25% reduction (weeks 5-7), 50% reduction (weeks 8-9), 75% reduction (week 10-11); and abstinence [CO < 4 parts per million (p.p.m.)] (week 12 until delivery). NCBI participants received incentives independent of smoking CO measurement results. TAU participants received no incentives, the standard treatment at the program. CBI condition participants submitted significantly lower mean CO values than the NCBI and TAU conditions over the course of the intervention (P < 0.0001). Nearly half (48%) of the CBI participants met the 75% smoking reduction target and one-third (31%) met the abstinence target at week 12. In contrast, none of the NCBI met either the 75% or abstinence targets. Only 2% of the TAU participants met the 75% reduction and none of the TAU participants met the abstinence targets. These smoking behavior reductions did not yield significant differences in birth outcomes. Cigarette smoking may be reduced significantly among pregnant, methadone-maintained women through the use of contingent reinforcement for gradual reductions in breath carbon monoxide levels.

Pregnancies exposed to methadone, methadone and other illicit substances, and poly-drugs without methadone: A comparison of fetal neurobehaviors and infant outcomes

BackgroundIt is suspected that there is a continuum of impairment among prenatally drug-exposed infants, such that opioid and/or poly-drug exposure confers the highest risk for adverse neonatal outcomes than other classes of substances or single substance exposures. Suitable control groups are difficult to identify. This study compared fetal neurobehavioral development and infant outcomes in offspring of three groups of pregnant women in drug treatment. Exposure groups include: Methadone+other illicit substances (MM+Poly) and two groups currently abstinent for poly drug exposures: Methadone only (MM/A) and Non-Methadone (NM/A). MethodsForty-nine women (19 MM+Poly, 18 MM/A, and 12 NM/A) underwent fetal monitoring at 36 weeks gestation at peak and trough levels of methadone (MM+Poly; MM/A) or at comparable morning and afternoon times (NM/A). Fetal heart rate (FHR), heart rate variability (FHRV) and motor activity (FM) data were collected. Infant measures included birth outcomes and Neonatal Abstinence Syndrome (NAS) assessment. ResultsAs compared to the NM/A group, cardiac measures were decreased in methadone-exposed fetuses at peak levels. FHR was significantly more suppressed in the MM+Poly group. FM was significantly lower in the MM/A vs. the NM/A group at both peak and trough, indicative of more persistent exposure effects. The MM+Poly group delivered 1 week earlier and required NAS pharmacological treatment twice as often as the MM/A group. ConclusionsResults support the notion that poly-drug exposure may potentiate the effects of methadone on the fetus and infant and highlights the need for intensified treatment for methadone-maintained women who abuse other substances.

Drugs of Dependency: The Pregnant Woman and Her Infant

The repercussions of drug abuse are particularly emphasized when a pregnant woman is affected. Gestational drugexposure is associated with significantly increased risks of poor maternal health, adverse perinatal outcomes, and unfavourable psychosocial consequences. Children affected by maternal drug use are at particular risk form their parent's drug seeking behavior as well as the toxicological effects of the drugs used. Early identification is key, and considerably more research is needed to develop the optimum means by which affected mother-infant dyads may be recognized and supported. In this special issue, we present six papers that deal with the problems caused by gestational drugs of dependency. “Pregnant and non-pregnant women in cape town, South Africa: drug use, sexual behavior, and the need for comprehensive services” deals with the problem of methamphetamine use in pregnant women in South Africa, a country where poverty and HIV risk are high. The authors find that methamphetamine, a drug highly associated with adverse psychosocial sequelae, is proportionally used by more pregnant than non-pregnant women, a practice that could have far-reaching effects on their families. “Drug testing for newborn exposure to illicit substances in pregnancy: pitfalls and pearls” in this special issue provides an overview of drug testing of newborns. Accurate recognition of a newborn whose mother has used illicit drugs during pregnancy influences decisions regarding healthcare of mother and infant whilst in hospital and following discharge. The difference between screening and confirmatory drug testing and the potential for false-positive results by immunoassay screening are discussed. Testing of newborns for illicit drugs can be done on urine, blood, meconium, hair, and umbilical cord blood or tissue samples. The implications and limitations of drug testing are presented. The authors caution that illicit drug use in pregnancy is not an independent predictor of a mother's ability to adequately care for her child but needs to be considered in health care planning. “Initial feasibility of a woman-focused intervention for pregnant African-American women” reports on the difficulties faced by drug-using women in accessing antenatal care and contraception compared to the general pregnant population. The authors discuss challenges faced in the development of innovative and effective systems to educate affected women and to provide adequate care for the women and their children. “Pharmacological treatment of neonatal opiate withdrawal: between the devil and the deep blue sea” deals with the issues faced by clinicians on how to optimize treatment of the newborn infant withdrawing from maternal opiates. They emphasize that current clinical research and evidence on the long term development of children affected by in utero opiate exposure is limited as are the effects of pharmacological treatment on these infants, especially when there is an increasing body of evidence suggesting that opiates may not have a benign influence on fetal or, indeed, neonatal neurodevelopment. “Psychosocial characteristics and obstetric health of women attending a specialist substance use antenatal clinic in a large metropolitan hospital” investigates the outcomes of a community-based intervention to improve drug-use behavior and social circumstances of crack-using African-American women. It highlights, in particular, the benefits of training in social skills such as relationship support to alleviate lifestyle issues associated with highly dependent drug-use behaviors. “Effectiveness of a smoking cessation intervention for methadone-maintained women: a comparison of pregnant and parenting women” examines the effects of an intervention aimed to reduce cigarette smoking for women in substance abuse programs. This is particularly important as cigarette smoking compounds the risk of adverse perinatal and neonatal outcomes in this population, and the paper highlights the benefits of addressing what would often be considered a trivial problem for the drug-using woman. Julee Oei Anne Bartu Lucy Burns Mohamed E. Abdel-Latif Chulathida Chomchai

Effectiveness of a Smoking Cessation Intervention for Methadone-Maintained Women: A Comparison of Pregnant and Parenting Women

Women in substance abuse programs have high rates of smoking. Pregnancy represents a unique opportunity for intervention, but few data exist to guide tailoring of effective interventions. In this study, 44 pregnant and 47 nonpregnant opioid-dependent women enrolled in comprehensive substance abuse treatment received a 6-week smoking cessation intervention based on the 5A's counseling model. The number of daily cigarettes decreased by 49% for pregnant patients and 32% for nonpregnant patients at the 3-month followup. Length of time in substance abuse treatment did not correlate with smoking cessation or reduction for either group. Factors predicting reduction of cigarette smoking differed for pregnant versus nonpregnant patients. For pregnant patients, lower levels of nicotine use prior to intervention and self-reported cigarette cravings predicted successful reduction in smoking. For nonpregnant patients, lower affiliative attachment to cigarettes, reliance on cigarettes for cognitive enhancement, and greater sense of control predicted more successful outcomes.

Perinatal Risk Factors for the Neonatal Abstinence Syndrome in Infants Born to Women on Methadone Maintenance Therapy

More than 50% of newborn infants whose mothers are on methadone maintenance therapy during pregnancy for opiate addiction develop neonatal withdrawal or neonatal abstinence syndrome (NAS). Although a large number of studies have investigated strategies that could predict the occurrence of NAS requiring pharmacological treatment, these studies have had conflicting results and identified no useful strategies. Maternal methadone dosing has been studied as a possible predictive risk factor for occurrence of NAS requiring treatment. Several studies have reported that methadone dosing may influence the onset of NAS. Other studies, however, found no correlation between the amount of methadone and NAS requiring treatment. In one study, the cumulative maternal methadone dose during pregnancy was predictive for the development of NAS. Gestational age and mode of delivery have also been reported to be associated with increased risk of NAS; the interaction between these 2 parameters and the last methadone dose has not been adequately investigated. This study was a retrospective review designed to investigate and correlate maternal methadone dose and other potential risk factors with the development of NAS requiring pharmacological treatment using clinical parameters easily accessible to clinicians. The study population was 228 methadone-maintained pregnant women who delivered 232 live-born infants between 2001 and 2006. A statistical model based on multiple logistic regression was developed to identify parameters predictive of subsequent need for treatment for NAS. External validation of the prediction model was provided by the use of a separate independent cohort of 188 infants born to methadone-maintained women. A total of 172 (74%) of the 232 infants were treated for NAS. The risk of withdrawal was associated with a higher last methadone dose and a higher cumulative dose (P < 0.001 for both). Infants delivered at a lower gestational age or by cesarean section were overall less likely to require NAS treatment. Gestational age, mode of delivery, and last methadone dose were identified as risk factors for withdrawal. External validation of the model developed from the original cohort was demonstrated in the validation cohort. These findings suggest that significant risk factors associated with the development of NAS requiring treatment are timing, mode of delivery, and the last maternal methadone dose. The statistical robustness of the data was demonstrated using internal and external validation methods.

Menopause Symptom Attribution Among Midlife Women in Methadone Treatment

This article describes menopause symptom attributions among 135 midlife methadone-maintained women between the ages of 40 and 55 years. A cross-sectional survey collected sample characteristics and a 14-item menopause symptom checklist. Following the checklist respondents were questioned regarding perceived symptom causality. For classic menopause symptoms (hot flashes, night sweats, and menstrual irregularities) a majority of women attributed menopause. For remaining symptoms, various attributions were reported or etiologies were unknown. How midlife women interpret their symptoms is important to understand since such appraisals may guide the type of health and treatment behaviors they choose. Education to promote understanding of the actual causes, diagnosis, and treatment of symptoms may encourage midlife women to seek appropriate intervention. Social workers treating midlife women must be aware of and understand the normal variations associated with menopause and the multifactor symptom etiology.

The effects of prenatal exposure to buprenorphine or methadone on infant visual evoked potentials

This study compared the neurological development of 4month old infants exposed to buprenorphine or methadone during pregnancy to that of a control group of non-exposed infants. Participants were 30 buprenorphine-maintained women, 22 methadone-maintained women and 33 non opioid-dependent controls, and their infants. Women were enrolled during pregnancy as part of an open-label non-randomised flexible-dosing longitudinal study. Groups were matched for maternal age, parity, gravida, and tobacco and alcohol use. Infant neurological development was assessed by measuring latency of pattern reversal visual evoked potentials (VEP). One-way between groups analyses of variance (ANOVA) were conducted to test the statistical significance of differences between the mean latencies of the peak response to two different sized checkerboard patterns (48′ and 69′ of retinal arc). Infants prenatally exposed to methadone had significantly prolonged latencies, compared with infants in the control group and infants prenatally exposed to buprenorphine, in response to checks of 48′ and 69′. VEP latencies of infants prenatally exposed to buprenorphine did not differ significantly from controls for either check size. After adjustment for covariates, prenatal exposure to methadone remained a significant predictor of VEP response to checks of 48′, but not 69′. Maternal self-reported used of marijuana during pregnancy made a significant unique contribution to the variance in P1 latencies for both check sizes. Data from this controlled, non-randomised study suggest that buprenorphine may confer an advantage over methadone as a maintenance drug during pregnancy in terms of infant neural development at 4months of age.

Relationship between Cigarette Use and Mood/Anxiety Disorders among Pregnant Methadone-Maintained Patients

This study investigates the association between cigarette use and current mood/anxiety disorders among pregnant opioid-dependent patients. Pregnant methadone-maintained women (N = 122) completed the Addiction Severity Index and Structured Clinical Interview for DSM-IV. Participants were categorized based on past 30 days cigarette use: no (n = 15) and any smoking (n = 107); this latter group was then subdivided into light (one to ten cigarettes/day; n = 55), and heavy smokers (11+ cigarettes/day; n = 52). Any smoking was significantly associated with any current mood/anxiety disorder (p < 0.001), any current mood disorder (p = 0.007), and any current anxiety disorder (p < 0.001). No significant association was found between specific level of cigarette use and mood/anxiety disorders. This association between smoking and psychiatric disorders has implications for the mental and physical health of methadone-maintained women and their children, and may contribute to the understanding of the physiological mechanisms underlying smoking and nicotine dependence.

Relationship between Cigarette Use and Mood/Anxiety Disorders among Pregnant Methadone-Maintained Patients

This study investigates the association between cigarette use and current mood/anxiety disorders among pregnant opioid-dependent patients. Pregnant methadone-maintained women (N = 122) completed the Addiction Severity Index and Structured Clinical Interview for DSM-IV. Participants were categorized based on past 30 days cigarette use: no (n = 15) and any smoking (n = 107); this latter group was then subdivided into light (one to ten cigarettes/day; n = 55), and heavy smokers (11+ cigarettes/day; n = 52). Any smoking was significantly associated with any current mood/anxiety disorder (p < 0.001), any current mood disorder (p = 0.007), and any current anxiety disorder (p < 0.001). No significant association was found between specific level of cigarette use and mood/anxiety disorders. This association between smoking and psychiatric disorders has implications for the mental and physical health of methadone-maintained women and their children, and may contribute to the understanding of the physiological mechanisms underlying smoking and nicotine dependence.

Monitoring methadone milk concentrations of methadone-maintained women in postpartum period for breastfeeding safety

Monitoring methadone milk concentrations of methadone-maintained women in postpartum period for breastfeeding safety

Maternal methadone dosing schedule and fetal neurobehaviour

Objective. Daily methadone maintenance is the standard of care for opiate dependency during pregnancy. Previous research has indicated that single-dose maternal methadone administration significantly suppresses fetal neurobehaviours. The purpose of this study was to determine if split-dosing would have less impact on fetal neurobehaviour than single-dose administration.Methods. Forty methadone-maintained women were evaluated at peak and trough maternal methadone levels on single- and split-dosing schedules. Monitoring sessions occurred at 36- and 37-weeks gestation in a counterbalanced study design. Fetal measures included heart rate, variability, accelerations, motor activity and fetal movement-heart rate coupling (FM-FHR). Maternal measures included heart period, variability, skin conductance, respiration and vagal tone. Repeated measure analysis of variance was used to evaluate within-subject changes between split- and single-dosing regimens.Results. All fetal neurobehavioural parameters were suppressed by maternal methadone administration, regardless of dosing regimen. Fetal parameters at peak were significantly lower during single versus split methadone administration. FM-FHR coupling was less suppressed from trough to peak during split-dosing versus single-dosing. Maternal physiologic parameters were generally unaffected by dosing condition.Conclusion. Split-dosed fetuses displayed less neurobehavioural suppression from trough to peak maternal methadone levels as compared with single-dosed fetuses. Split-dosing may be beneficial for methadone-maintained pregnant women.