Opioid Maintenance Therapy Research Articles

Abwägung von Nutzen und Schädlichkeit von berauschenden und schmerzlindernden Substanzen aus der Perspektive von deutschen Suchtmedizinern

In Europe, there have been several addiction-expert rankings of harms related to the use of psychotropic substances in the last 15 years. Among them, only one expert ranking took into account the potential benefits of these drugs. Non-Opioidergic Analgesics (NOAs), such as gabapentinoids and NSAIDs, which have been increasingly the subject of abuse / misuse reports, have not been considered in such expert rankings. Likewise, there is currently no multi-substance comparison as to whether the valuation rank of the harmfulness of an illegal drug may change along with an imagined change in legal status in Germany. Using a questionnaire, 101 experienced addiction physicians (first cohort) evaluated 33 psychoactive substances including analgesics with regard to their health and social harms as well as potential usefulness for the consumer and their environment / society ('others'). In addition, this cohort investigated whether the harmfulness assessment of an illegal substance changes if it would be legalized. In order to obtain the average overall harmfulness (overall risk) of a substance, the percentage contribution of each dimension to the overall harmfulness was determined in a second survey (second cohort, 36 experienced addiction medicine experts). Finally, the average benefit and overall risk ratings of each substance were related to each other. Prescription psychoactive substances such as analgesics, NOAs (including gabapentinoids) and opioidergic maintenance medications to treat opiate dependence were judged to have a favorable benefit-harm profile. Cannabis and ketamine were placed in the midfield of both, the harm and benefit rankings. Together with most illicit narcotic drugs, alcohol and nicotine, have been ranked among the most harmful and least useful substances, whereby alcohol was judged on average to be more harmful but also more useful than nicotine. In the event of potential legalization, the overall harm of the traditional illegal drugs methamphetamine, heroin, cocaine and cannabis was estimated to be reduced. This was mainly due to a more favorable valuation of the harm to others under these virtual conditions. Prescription substances including opioidergic and non-opioidergic analgesics as well as opioid maintenance therapy medications (methadone and buprenorphine) were assigned a favorable benefit-harm profile. Alcohol, nicotine and traditional illicit drugs (with the exception of cannabis and ketamine) were determined to have an unfavorable profile. The overall harm of traditional illicit drugs was assessed to decrease along with legalization, mainly by decreasing the harm to others in this virtual event.

1022 Opioid maintenance therapy prescription by obstetricians and postpartum visit compliance

Women with opioid use disorders (OUD) are particularly vulnerable in the postpartum period. Increased rates of mental health crises and relapse rates underscore the importance of compliance with postpartum care in this population. This study aimed to evaluate the relationship of the provider prescribing opioid maintenance therapy (OMT) and the subsequent compliance with the 6 week postpartum (PP) visit. This retrospective cohort study identified patients through the institutions’ Maternal Opioid Management Support (MOMS) program as those receiving OMT (defined as use of methadone or buprenorphine) from 2017 to 2020. The primary outcome was attendance of the 6 week PP visit. Prenatal care provider comparison was done between the MOMS clinic and other obstetric providers. Statistical analysis included Chi square tests, student t tests, and logistic regression modeling and was performed with significance levels of <0.05 using R Studio (V1.2.5042). Characteristics independently associated with compliance were included in the model. Of 199 women receiving OMT during pregnancy, 54.8% (109) were compliant with the 6 week PP visit and 45.2% (90) were noncompliant. Both groups demonstrated similarity in maternal age, race, marital status, employment, detox during pregnancy, active drug use in pregnancy, gestational age at delivery, and maternal comorbidities. Among the 109 women compliant with their PP care, 83% received OMT from an OB prescriber vs 40% by a non-OB prescribers (e.g. methadone/pain clinic, PCP) (p= <0.001). In a regression model, having a postpartum OB OMT prescriber was an independent predictor of 6 week PP visit compliance (OR 5.40; 95%CI: 2.35 – 13.36). (Table 1) Access to OMT received directly from a woman’s prenatal provider may be a predictive factor in increasing PP visit compliance. Additionally, it provides an important opportunity to screen, support, and treat this population of women who are at a significantly elevated risk of complications.

Acute pain management among patients with opioid maintenance therapy: specificities and difficulties identified in primary care: a qualitative study

ObjectivesIn the last 30 years, opioid maintenance treatment prescription (OMT) has changed patients’ and also changed physicians’ practices. General practitioners (GPs) have to deal with patients on OMT who are...

Heroin-assisted treatment of heroin-addicted patients normalizes regulatory T cells but does not restore CD4+ T cell proliferation.

Heroin dependence may result in suppression of adaptive immune responses. Previously, we demonstrated an increase in relative numbers of inhibitory CD4+ regulatory T cells (Tregs) and impaired proliferative activity of CD4+ T cells from heroin-addicted patients in contrast to patients in opioid maintenance therapy and healthy controls. However, it remains elusive whether heroin has a direct impact on the CD4+ T cell compartment or whether observed effects result from stressful living conditions. Here, we analyzed the frequencies of Tregs and the proliferation as well as the cytokine production of stimulated CD4+ T cells from heroin-addicted patients with use of illicit heroin, patients in heroin-assisted treatment (HAT), and patients in methadone maintenance therapy (MMT). Relative numbers of CD4+ Tregs were significantly enhanced in patients with illicit heroin abuse compared with patients in HAT or MMT. Notably, CD4+ T cells from patients in HAT and from persons using illicit heroin showed significant reduced proliferation and secretion of the pro-inflammatory cytokines IFN-γ and IL-6 upon stimulation in vitro. From these results, we conclude that structured programs such as HAT and MMT dampen elevated frequencies of Tregs in heroin-addicted patients, whereas chronic heroin administration irrespective of using illicit heroin or receiving HAT has a direct impact on the proliferative activity and cytokine production of CD4+ T cells.

Managing drugs in the prisoner society: heroin and social order in Kyrgyzstan's prisons.

Through the case study of Kyrgyzstan this paper argues that a rapidly increasing availability of drugs in prison is not necessarily deleterious to solidarity and inmate codes. Instead, the fragmentary effect of drugs depends on the forms of prisoner control over drug sale and use. In Kyrgyzstan, prisoners co-opted heroin and reorganized its distribution and consumption through non-market mechanisms. State provision of opioid maintenance therapy incentivized powerful prisoners to move to distributing heroin through a mutual aid fund and according to need. Collectivist prison accommodation, high levels of prisoner mobility and monitoring within and across prisons enabled prisoners to enforce informal bans on drug dealing and on gang formation outside of traditional hierarchies. We argue that in these conditions prisoners organized as consumption-oriented budgetary units rather than profit-driven gangs.

In utero opioid exposure and risk of infections in childhood: A multinational Nordic cohort study.

There is an increasing number of children with in utero exposure to opioids. Knowledge about opioid safety in pregnancy, particularly for outcomes later in childhood is scarce. It has been suggested that opioids can modulate immune system and increase the risk of infections. Our goal was to study the impact of in utero opioid exposure on the immune system and the risk of infections in childhood. This population-based cohort study used nationwide registers from Denmark, Norway, and Sweden. Among pregnant women we identified users of opioids for two different indications, opioids used in opioid maintenance therapy (OMT) and opioids used for treatment of pain. We followed the exposed children and studied susceptibility for infections measured as number of antibiotic prescriptions expressed as Incidence rate ratios (IRRs) and diagnoses in specialist health care expressed as hazard ratios (HRs). After adjustment we did not observe increased risk for filling antibiotic prescriptions in children exposed to OMT opioids compared with OMT discontinuers (IRR, 1.08; 95% CI 0.81-1.44 in Norway and Sweden, and IRR, 0.74; 95% CI 0.63-0.88 in Denmark), or for diagnosis of infection in specialist health care (HR 0.83; 95% CI 0.55-1.26 in Norway and Sweden, and 0.82; 95% CI 0.62-1.10 in Denmark). In this population-based cohort study, we did not observe increased risk of infections among children prenatally exposed to OMT opioids when compared to OMT discontinuers, nor long-term analgesic opioids exposed when compared to short-term analgesic opioids exposed.

A Preliminary Report on the Largest Ongoing Outbreak of Lead Toxicity in Iran

No countrywide data exists on the patients’ characteristics of lead exposure in Iran. We aimed to evaluate the demographic characteristics and blood lead level (BLL) of these patients in the country scale during five consecutive years, including the epidemic outbreak year (2016). Between 2014 and 2018, records of all patients who had referred to two reference laboratories in Tehran, Iran, to check BLL were evaluated. Of 58,642 patients, 48,589 were male. Mean age was 44.9 ± 20.7 years. Males had higher BLLs and were significantly older. Median BLL was 16 µg/dL (0.3 to 263 µg/dL). Median BLL was significantly higher in 45- to 60-year-old patients. The highest median BLL was reported in May 2016 confirming our records about the peak of the epidemic. Although the frequency of high BLL declined after 2016, it never returned to the measures before that. Considering the ongoing high prevalence of increased BLLs after 2016 and similar environmental and occupational exposures as before, lead-contaminated opium still seems to persist in the Iranian opium black market. Substitution of this lead-contaminated opium by Opioid Maintenance Therapy (OMT)-prescribed opium tincture is recommended.

The Role of the Medical School Training on Physician Opioid Prescribing Practices: Evidence from Ontario, Canada: Le rôle de la formation à la faculté de médecine à l'égard des pratiques de prescription d'opioïdes des médecins: données probantes d'Ontario, Canada.

Background:Recent research found that physicians who completed medical school training at top-ranked U.S. medical schools prescribed fewer opioids than those trained at lower ranked schools, suggesting that physician training may play a role in the opioid epidemic. We replicated this analysis to understand whether this finding holds for Ontario, Canada.Methods:We used data on all opioid prescriptions written by Ontario physicians between 2013 and 2017 from the Narcotics Monitoring System. Using the Corporate Provider Database and ICES Physician Database, which contain medical school of training, we linked patients who filled opioid prescriptions with their respective prescribing physician. Available data on Canadian medical school rankings were obtained from Maclean’s news magazine. We used regression analysis to assess the relationship between number of opioid prescriptions and medical school ranking.Results:Compared to the United States, average annual number of opioid prescriptions per physician was lower in Ontario (236 vs. 78). Unlike the United States, we found little evidence that physicians trained at lower ranked medical schools prescribed more than their top-ranked school counterparts after controlling for specialty and location of practice. However, primary care physicians trained at non-English-speaking foreign schools prescribed the most opioids even after excluding opioid maintenance therapy–related prescriptions.Conclusion:The role of medical school training on opioid prescribing patterns among Ontario physicians differs from that in the United States likely due to greater homogeneity of curricula among Canadian schools. Ensuring physicians trained abroad receive additional pain management/addiction training may help address part of the opioid epidemic in Ontario.

Opioid Maintenance Therapy (OMT) Outcomes on Maternal Weight Gain [24E

INTRODUCTION: The Institute of Medicine's (IOM) guidelines provide recommendations for appropriate gestational weight gain based solely on pre-pregnancy body mass index (BMI). Opioid use disorders (OUD) are known risk factors for poor nutrition and inadequate weight gain. We sought to compare methadone vs buprenorphine OMT effects on obtaining appropriate maternal weight gain. METHODS: We conducted an IRB approved retrospective cohort study using electronic medical records from an academic center between 2007 and 2017. Inclusion criteria: women with a singleton pregnancy receiving OMT with either methadone or buprenorphine. Exclusion criteria: women with a pre-viable delivery, multiple gestation pregnancy, or anomalous fetus incompatible with life. We compared both OMT groups for differences in insufficient, appropriate, or excessive weight gain based upon IOM's guidelines. P-value &lt;.05 was considered significant. RESULTS: 181 pregnancies were analyzed. 51% (n=93) received buprenorphine and 49% (n=88) received methadone. Patients in the methadone arm were more likely to be prescribed medications at a methadone/pain clinic vs OB provider (P&lt;.05). Baseline demographics for both groups were similar in age, parity, race and BMI. There were no statistically significant differences in inadequate, appropriate, or excessive weight gain between the 2 groups (P=.47). Additionally, there were no statistical differences between the groups regarding recommended weight gain, regardless of BMI (P=.53). CONCLUSION: The findings amongst our cohorts revealed there is no superiority of either OMT selection to achieve the recommended weight gain in pregnancy. This data illustrates that the decision to select the optimal OMT should be guided by other factors than achieving the ideal weight gain.

Effects of Breastfeeding on NAS Symptom Severity, Infant Pharmacologic Use, and Length of Hospital Stay [12O

INTRODUCTION: Prenatal opioid maintenance therapy (OMT) exposure is associated with neonatal abstinence syndrome (NAS) (Finnegan, Connaughton et al., 1975). Our study examines the effects of breastfeeding on NAS symptom severity, pharmacologic use, and length of treatment. METHODS: Data was extracted retrospectively from the medical charts of 74 infants born to mothers on OMT at Carilion Roanoke Memorial Hospital (CRMH) and analyzed using propensity score matching, which examines group differences in outcome while controlling for pre-existing differences in background variables (Rosenbaum &amp; Rubin, 1985). IRB approval was obtained. RESULTS: Of the sixty infants included, at five days old thirty were being fed formula only, thirteen were breastfed only, and seventeen were fed both breastmilk and formula. Propensity score matching was used to match the thirteen breastmilk only infants to thirteen of the formula-only infants. Mean peak NAS Finnegan scores in the formula and breastmilk groups were 11.54 and 6.54, respectively (P=.03). Mean length of infant pharmacologic treatment was 1.46 months for formula fed infants and .33 months for breastfed infants (P=.02). Among matched pairs with one infant receiving pharmacologic treatment and one not receiving treatment, the formula fed infant was more likely to have received pharmacologic treatment (P=.04). CONCLUSION: This study shows that breastfeeding decreases symptom severity, infant pharmacologic use and length of pharmacologic treatment. The use of propensity matching accounts for confounding variables more appropriately than previous studies, likely increasing the reliability of the findings.

Continuation in Treatment and Maintenance of Custody of Newborns After Delivery in Women With Opioid Use Disorder.

To identify variables associated with continuation in treatment and maintenance of custody after pregnancies in women with opioid use disorder (OUD). The medical records of pregnant women with documented OUD from 2011 to 2018 and with at least 6 months follow-up postpartum were retrospectively reviewed. Via multivariate analysis, women on opioid maintenance therapy (OMT) were more likely to continue in treatment and maintain custody, whereas women enrolled in a residential treatment program during pregnancy were less likely to continue in treatment or maintain custody. Women who continued in treatment were significantly more likely to maintain custody of their children than those who did not. Continuation in treatment and maintenance of custody were closely related. Care providers should attempt to improve both outcomes.

Buprenorphine\u2013cannabis interaction in patients undergoing opioid maintenance therapy

Buprenorphine is a partial μ-opioid agonist widely used for opioid maintenance therapy (OMT). It is mainly metabolized to pharmacologically active norbuprenorphine by the cytochrome P450 (CYP) isozyme 3A4. This may give rise to drug–drug interactions under combinations with inhibitors or inducers of CYP3A4. Cannabis is a potential inhibitor of CYP3A4, and there is a large degree of concomitant cannabis use among OMT patients. We performed a retrospective analysis on liver healthy OMT patients substituted with buprenorphine, either with (n = 15) or without (n = 17) concomitant use of cannabis. Patients with additional illicit drugs or medications affecting CYP3A were excluded. Measured blood concentrations of buprenorphine and norbuprenorphine were compared between the two groups. Cannabis users and non-users received similar doses, but users had 2.7-fold higher concentrations of buprenorphine (p < 0.01) and 1.4-fold for norbuprenorphine (1.4-fold, p = 0.07). Moreover, the metabolite-to-parent drug ratio was 0.98 in non-users and 0.38 in users (p = 0.02). Female gender did not produce significant effects. These findings indicate that cannabis use decreases the formation of norbuprenorphine and elevates buprenorphine and norbuprenorphine concentrations in blood most probably by inhibition of CYP3A4. The pharmacokinetic interaction may give rise to enhanced or altered opioid activity and risk of intoxications. Physicians should inform patients about this risk and supervise cannabis users by regular control of buprenorphine blood levels, i.e., by therapeutic drug monitoring.

&lt;p&gt;An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification&lt;/p&gt;

BackgroundGiven that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.Methods300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6–8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.ResultsOf the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.ConclusionAfter detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

678: Comparison of Opioid Maintenance Therapy (OMT) on prenatal and postnatal growth effects

678: Comparison of Opioid Maintenance Therapy (OMT) on prenatal and postnatal growth effects

The Impact of Hepatitis C Virus Infection on Buprenorphine Dose in Pregnancy.

Buprenorphine (BUP) is commonly used for opioid maintenance therapy in pregnancy. Our goal was to determine whether liver dysfunction related to hepatitis C virus (HCV) infection impacts BUP dosing requirements in pregnancy. This was a retrospective cohort study of pregnant women with antenatal exposure to BUP to compare dosing between individuals positive versus negative for HCV infection. Spearman correlation tests were used to assess the relationship between BUP dose and HCV status. HCV infection was present in 103 (39%) of the patients. Patients with HCV infection required lower dose increases of BUP throughout pregnancy (p = 0.02). HCV viral load was positively correlated with the liver enzymes aspartate transaminase (r = 0.30, p = 0.003) and alanine transaminase (r = 0.25, p = 0.01). There was a negative correlation between HCV viral load and BUP dose during the second trimester (r = -0.27, p = 0.01) and third trimester (r = -0.20, p = 0.04). Women with HCV infection required less of an increase in BUP dose throughout pregnancy compared with women without HCV infection. Severity of HCV infection, as measured by viral load and liver enzymes, was also associated with BUP dosing.

Gestational buprenorphine exposure: Effects on pregnancy, development, neonatal opioid withdrawal syndrome, and behavior in a translational rodent model

BackgroundThe opioid crisis has led to an increased number of pregnant opioid-dependent women receiving opioid-maintenance therapy (e.g. buprenorphine, BUP), but little is known about the consequences of gestational BUP exposure on pregnancy outcomes, maternal care, or offspring development. MethodsOur translational rodent model began BUP exposure to adult female rats (N = 30) at least 7 days before conception and continued throughout the postpartum period. Both therapeutic low-dose (BUP-LD, 0.3 mg/kg, s.c.) and overexposure high-dose (BUP-HD, 1.0 mg/kg) doses of BUP were compared to saline control. Female rats were bred in house with drug-naïve adult male rats. The day after parturition, litters were culled to 5 males/5 females and assigned randomly to various behavioral tests and assessed either neonates or adolescents. Litter characteristics, maternal caregiving, Neonatal Opioid Withdrawal Syndrome (NOWS), offspring development and adolescent behaviors were evaluated. ResultsBUP-LD decreased maternal care, delayed offspring development, decreased offspring body weight, length, temperature, and pain sensitivity (p’s < .05). BUP-HD drastically reduced maternal care and offspring survival, altered litter characteristics, and increased NOWS (p’s < .05). ConclusionThese results demonstrate that the therapeutic BUP-LD in rats was relatively safe with subtle effects on maternal care and rodent offspring. However, overexposure BUP-HD in rats produced NOWS and compromised maternal caregiving as well as rodent offspring survival. More research is critical to validate the translational implication of these findings for human opioid-dependent mothers maintained on BUP-maintenance therapy.

Harm reduction drug policy in Israel: what has been accomplished and what still needs to be done?

The leading formal drug policy in Israel is the traditional approach of abstinence, probation, and punitive measures based on three main pillars: Enforcement, Treatment and Rehabilitation, and Prevention. However, under the treatment pillar, Israel has adopted a number of harm reduction services, focused mostly on people who use heroin and people who inject drugs. These include Methadone Maintenance Treatment, Buprenorphine Maintenance Treatment, and Needle and Syringe Exchange Programs. More specialized services are designated mostly for people who use drugs, who frequent the largest open drug scene in Tel-Aviv. These include a health clinic, an emergency apartment for female addict sex-workers, and a ‘First Step’ center. Even so, the harm reduction approach has remained controversial, stigmatized, and is considered a sub-category for total-abstinence treatment in Israel. This paper follows the evolution of harm reduction interventions in Israel among people who use drugs and sheds light on the lack of a comprehensive, well-planned, formal national harm reduction drug policy. Additionally, this article expresses concern over the uncertain future of Israel’s comprehensive and balanced drug treatment policies caused by the structural changes in abolishing the Israel Anti-Drug Authority, the statutory authority and central body in Israel that promoted and coordinated all national policies related to treatment and harm reduction.ConclusionsAlthough it is a major challenge to translate worldwide evidence and research findings into action and social change, recommendations are offered to implement a comprehensive harm reduction drug policy led by a multidisciplinary group of policy-makers across all areas of drug policy. These focus on expanding and developing more services for Opioid Maintenance Therapy patients and people who inject drugs as well as a national effort to reduce high levels of stigma and discrimination against them, encompassing other common substances and focusing on populations such as adolescents and young adults that engage in other types of substance use such as cannabis, amphetamine-type stimulants, and hallucinogens.

Does the Addition of Naloxone in Buprenorphine/Naloxone Affect Retention in Treatment in Opioid Replacement Therapy?: A Systematic Review and Meta-Analysis.

Opioid maintenance therapy is an evidence-based first-line treatment approach to reduce the problems associated with opioid use disorders. Buprenorphine and methadone are the two most commonly recommended pharmacotherapies. Individuals who remain in treatment longer tend to have a reduced drug use, a higher social functioning, and a higher quality of life. The addition of naloxone to buprenorphine (bup/nx) was developed, in part, to help increase retention in treatment. However, this has not been shown in research. The objective of this review was to examine whether bup/nx is more effective than buprenorphine and methadone, to ultimately determine whether the addition of naloxone shows a clinical difference. The literature search was conducted using the electronic databases PubMed, Embase, and Cochrane. Search strategies were thoroughly developed and modified for each database by combining relevant MeSH and Emtree terms as well as keywords such as "bup/nx," "buprenorphine," and "naloxone." The outcome measure was treatment retention, as determined by the number of days a participant remains in a treatment program. There were four studies included in the review. The data were analyzed with Review Manager software. There was no statistically significant result for bup/nx compared with methadone or buprenorphine. Bup/nx may be an alternative to standard treatments such as buprenorphine and methadone as the addition of naloxone does not affect retention in treatment.

Salivary cortisol levels relate to cognitive performance in children prenatally exposed to methadone or buprenorphine.

Opioid maintenance therapy (OMT) is generally recommended for pregnant opioid-dependent women. However, much is still unknown about the potential long-term effects of prenatal methadone and buprenorphine exposure. This study explored the long-term effects of prenatal methadone and buprenorphine exposure in a cohort (n=41) of children, aged 9-11years, using the Wechsler Abbreviated Scale of Intelligence (WASI) to measure cognitive development and salivary cortisol samples to measure HPA-axis activity. Prenatally exposed children scored significantly lower on all four subtests of WASI (vocabulary, similarities, block design, and matrix reasoning), compared to a comparison group (all p<.05). No group differences were found for salivary cortisol levels or cortisol reactivity levels (all p>.05). Cortisol levels significantly predicted matrix reasoning scores for the OMT group, β=-65.58, t(20)=15.70, p=.02. Findings suggest that prenatal exposure to methadone or buprenorphine does not have long-term effects on children's HPA-axis functioning. However, since children of women in OMT scored significantly lower on tasks of cognitive function, careful follow-up throughout the school years and across adolescence is recommended.

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice.

Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations. CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy. Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population.