Opioid Use Disorder In Pregnancy Research Articles

Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy

Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy

Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy

BackgroundOpioid agonist therapy is strongly recommended for pregnant persons with opioid use disorder. Buprenorphine may be associated with more favorable neonatal and maternal outcomes than methadone, but existing data are limited.MethodsWe conducted a cohort study involving pregnant persons who were enrolled in public insurance programs in the United States during the period from 2000 through 2018 in which we examined outcomes among those who received buprenorphine as compared with those who received methadone. Exposure to the two medications was assessed in early pregnancy (through gestational week 19), late pregnancy (gestational week 20 through the day before delivery), and the 30 days before delivery. Risk ratios for neonatal and maternal outcomes were adjusted for confounders with the use of propensity-score overlap weights.ResultsThe data source for the study consisted of 2,548,372 pregnancies that ended in live births. In early pregnancy, 10,704 pregnant persons were exposed to buprenorphine and 4387 to methadone. In late pregnancy, 11,272 were exposed to buprenorphine and 5056 to methadone (9976 and 4597, respectively, in the 30 days before delivery). Neonatal abstinence syndrome occurred in 52.0% of the infants who were exposed to buprenorphine in the 30 days before delivery as compared with 69.2% of those exposed to methadone (adjusted relative risk, 0.73; 95% confidence interval [CI], 0.71 to 0.75). Preterm birth occurred in 14.4% of infants exposed to buprenorphine in early pregnancy and in 24.9% of those exposed to methadone (adjusted relative risk, 0.58; 95% CI, 0.53 to 0.62); small size for gestational age in 12.1% and 15.3%, respectively (adjusted relative risk, 0.72; 95% CI, 0.66 to 0.80); and low birth weight in 8.3% and 14.9% (adjusted relative risk, 0.56; 95% CI, 0.50 to 0.63). Delivery by cesarean section occurred in 33.6% of pregnant persons exposed to buprenorphine in early pregnancy and 33.1% of those exposed to methadone (adjusted relative risk, 1.02; 95% CI, 0.97 to 1.08), and severe maternal complications developed in 3.3% and 3.5%, respectively (adjusted relative risk, 0.91; 95% CI, 0.74 to 1.13). Results of exposure in late pregnancy were consistent with results of exposure in early pregnancy.ConclusionsThe use of buprenorphine in pregnancy was associated with a lower risk of adverse neonatal outcomes than methadone use; however, the risk of adverse maternal outcomes was similar among persons who received buprenorphine and those who received methadone. (Funded by the National Institute on Drug Abuse.)

Explaining Racial-ethnic Disparities in the Receipt of Medication for Opioid Use Disorder during Pregnancy.

Factors contributing to racial and ethnic disparities in medication for opioid use disorder (MOUD) receipt during pregnancy are largely unknown. We quantified the contribution of individual, healthcare access and quality, and community factors to racial-ethnic disparities in MOUD during pregnancy and postpartum among Medicaid-enrolled pregnant women with opioid use disorder (OUD). This retrospective cohort study used regression and nonlinear decomposition to examine how individual, healthcare access and quality, and community factors explain racial-ethnic disparities in MOUD receipt among Medicaid-enrolled women with OUD who had a live birth from 2011 to 2017. The exposure was self-reported race and ethnicity. The outcomes were any MOUD receipt during pregnancy or postpartum. All factors included were identified from the literature. Racial-ethnic disparities in individual, healthcare access and quality, and community factors explained 15.8% of the racial-ethnic disparity in MOUD receipt during pregnancy and 68.9% of the disparity in the postpartum period. Despite comparable healthcare utilization, non-White/Hispanic women were diagnosed with OUD 37 days later in pregnancy, on average, than non-Hispanic White women, which was the largest contributor to the racial-ethnic disparity in MOUD receipt during pregnancy (111.0%). The racial-ethnic disparity in MOUD receipt during pregnancy was the largest contributor (112.2%) to the racial-ethnic disparity in MOUD in the postpartum period. Later diagnosis of OUD in pregnancy among non-White/Hispanic women partially explains the disparities in MOUD receipt in this population. Universal substance use screening earlier in pregnancy, combined with connecting patients to evidence-based and culturally competent care, is one approach that could close the observed racial-ethnic disparity in MOUD receipt.

What is the most accurate screening tool for detecting opioid use disorder in pregnancy?

University of Chicago (NorthShore) Family Medicine Program, Glenview, IL The corresponding author is Maryam Ahmad, MD; [email protected]. The author declares no conflicts of interest.

Comparison of neonatal outcomes in pregnant women undergoing medication-assisted treatment of opioid use disorder with methadone or buprenorphine/naloxone

Introduction The number of pregnant women with opioid use disorder (OUD) has quadrupled from 1999 to 2014. Current first line treatment for OUD in pregnancy is methadone with increasing support for buprenorphine. Limited data exist on use of buprenorphine/naloxone for OUD in pregnancy despite it being standard therapy in the non-pregnant individuals. The aim of this study was to compare neonatal opioid withdrawal syndrome (NOWS) prevalence and characteristics among neonates born to women prescribed methadone and buprenorphine/naloxone. Methods This is a retrospective cohort analysis of mother–neonate dyads treated with either methadone or buprenorphine/naloxone for OUD in pregnancy who received prenatal care in the substance abuse, treatment, education, and prevention program (STEPP) clinic and delivered at OSU. Primary neonatal outcomes included: neonates diagnosed and treated for NOWS, peak scores on Modified Finnegan Neonatal Abstinence Score (FNAS), number of scores ≥9 on FNAS, and duration of treatment for NOWS. Secondary outcomes included: fetal growth restriction, preterm birth (<37 weeks), neonatal head circumference, birth weight, NICU admission, five-minute Apgar score, and length of hospitalization. Results From 2013 to 2017, we identified 588 mother–neonate dyads: 149 treated with methadone and 439 treated with buprenorphine/naloxone. Ninety-eight neonates (65.8%) in the methadone group were diagnosed with NOWS requiring pharmacological interventions compared with 170 (38.7%) in the buprenorphine/naloxone group (aOR 3.46, 95% confidence interval (CI) 2.31–5.20, p < .01). Methadone-exposed neonates were six times more likely to be treated with >1 medication for NOWS (aOR 6.32, 95% CI 2.20–18.13, p < .01). Fetal growth restriction was diagnosed more often in the methadone group compared to the buprenorphine/naloxone group (aOR 1.73, 95% CI 1.02–2.93, p < .01). Significant maternal findings were that women using methadone for OUD started PNC earlier (15w vs. 17w, p = .04) and were less likely to be taking selective serotonin-reuptake inhibitors (SSRIs) (15% vs. 25%, p = .02) compared to the buprenorphine/naloxone group. Conclusions Buprenorphine/naloxone treatment for OUD in pregnancy appears safe and has decreased NOWS and pharmacologic intervention for the neonate.

Buprenorphine-naloxone Versus Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy.

Data regarding treatment outcomes with the use of buprenorphine-naloxone (BUP-NX) in pregnancy are scarce. The objective of this study is to examine the outcomes in a cohort of pregnancies treated with BUP-NX versus buprenorphine (BUP). This single-center, retrospective cohort study examined birthing person-infant dyads treated with BUP-NX versus BUP. The primary birthing person outcome was return to opioid use in pregnancy. The primary neonatal outcome was the need for pharmacologic treatment for neonatal opioid withdrawal syndrome (NOWS). The BUP-NX and the BUP treatment groups included 33 and 73 dyads, respectively. Except for psychiatric medication use, all demographics were similar between groups. In the final regression models, neither the birthing person nor the neonatal outcomes differed. The adjusted odds ratio for return to use during pregnancy for the BUP-NX versus BUP groups was 1.93 (95% confidence interval, 0.78-4.76). The adjusted odds ratio for pharmacologic treatment of NOWS for the BUP-NX versus BUP groups was 0.65 (95% confidence interval, 0.27-1.54). Among a subgroup of persons who transitioned from BUP to BUP-NX mid-pregnancy, there was no proximate return to use or need for dose increase. Compared with BUP, the use of BUP-NX in pregnancy is not associated with a higher risk of return to opioid use or a higher need for pharmacological treatment for NOWS.

Implementing a Statewide Speakers Bureau to Address Maternal Morbidity and Mortality

ObjectiveTo implement a speakers bureau to educate providers, health caregivers, and staff practicing within Tennessee hospitals on evidence-based practice recommendations related to opioid use disorder in pregnancy, postpartum hemorrhage, maternal hypertension, and implicit bias. DesignQuality improvement project. Setting/Local ProblemMultiple health care facilities throughout Tennessee, where rates of pregnancy-related mortality are greater than the national average and where Black women are three times as likely as White women to die of pregnancy complications. ParticipantsSpeakers (n = 47) included obstetricians, advanced practice providers, and nurses. Program attendees (n = 369) included providers and caregivers representing five health care facilities. Intervention/MeasurementsSpeakers were provided standardized training to disseminate best practice methods. Current evidence-based presentations regarding the top maternal mortality concerns were formatted for educational events at five Tennessee health care facilities. Independent outcome measures using electronic survey instruments were collected for speakers and audience participants. Speakers evaluated training methods, and participants evaluated the quality and efficacy of the information provided. ResultsBased on speaker evaluations, 70.59% rated the quality of training as 5 of 5, and 76.47% rated the relevance of training as 5 of 5. Overall, 16 of 17 (94.1%) speakers stated that adequate training was provided. Analysis of participant evaluations reported that 57.5% were very confident (5/5) that the information learned through the speakers bureau will improve their care of pregnant and postpartum people. Additionally, 71% were very likely (5/5) to apply the information to their practice. ConclusionThis project showed the dissemination of best practices by promoting knowledge, supporting practice change, and improving retained information in maternity providers and caregiver participants. Implementation of speakers bureaus to educate providers and caregivers within health care facilities has the potential to influence practice change and decrease maternal morbidity and mortality rates in the state of Tennessee.

Differences in Mortality Among Infants With Neonatal Opioid Withdrawal Syndrome

Prior studies are mixed regarding whether infants diagnosed with neonatal opioid withdrawal syndrome have a higher risk of mortality than other infants. However, these studies have not accounted for whether mothers of infants with neonatal opioid withdrawal syndrome received medication for opioid use disorder in pregnancy. Linked data from 2016‒2018 North Carolina birth certificates, maternal and infant Medicaid claims, and infant death certificates were analyzed in summer 2021 to compare mortality and causes of mortality before age 1 year among infants diagnosed with neonatal opioid withdrawal syndrome whose mothers did and did not have claims for medication for opioid use disorder in pregnancy (N=4,480). Compared with mothers with medication for opioid use disorder claims in pregnancy (45.5%), mothers without medication for opioid use disorder claims (55.5%) were younger, more likely to be Black non-Hispanic, less likely to have paternity established, and more likely to have no prenatal care. The proportion (1.3%, n=31 vs 1.0%, n=21) and rate (3.5 vs 2.9 deaths per 100,000 infant days) of mortality was higher among infants of mothers without medication for opioid use disorder claims than infants of mothers with medication for opioid use disorder claims. Sudden unexpected infant death syndrome was the primary cause of death for infants of mothers with (90.5%) and without (58.1%) medication for opioid use disorder claims. Results highlight the importance of assessing for potential differences in outcomes according to whether infants with neonatal opioid withdrawal syndrome were exposed to medication for opioid use disorder. Efforts to ensure equitable access to medication for opioid use disorder and other support services in pregnancy are needed to promote healthy maternal and infant outcomes.

Perinatal methadone exposure attenuates myelination and induces oligodendrocyte apoptosis in neonatal rat brain.

Methadone (MTD) is a commonly prescribed treatment for opioid use disorder in pregnancy, despite limited information on the effects of passive exposure on fetal brain development. Animal studies suggest a link between perinatal MTD exposure and impaired white matter development. In this study, we characterized the effect of perinatal MTD exposure through the evaluation of oligodendrocyte development and glial cell activation in the neonatal rat brain. Six pregnant Sprague Dawley rat dams were randomized to MTD (0.2 mL/L) or untreated drinking water from embryonic day 7. Pups were terminated at postnatal day 7 and tissue sections were harvested from six randomly selected pups (one male and one female per litter) of each experimental group for immunohistochemistry in areas of corpus callosum (CC), lateral CC, external capsule (EC), and cerebellar white matter. In the MTD-exposed rat pups, myelination was significantly decreased in the CC, lateral CC, EC, and arbor vitae compared with the controls. The increased density and percentage of oligodendrocyte precursor cells (OPCs) were observed in the CC and cerebellar white matter. The highly active proliferation of OPCs as well as decreased density and percentage of differentiated oligodendrocytes were found in the cerebellum but no differences in the cerebrum. Apoptotic activities of both differentiated oligodendrocytes and myelinating oligodendrocytes were significantly increased in all regions of the cerebrum and cerebellum after MTD exposure. There was no quantitative difference in astrocyte, however, cell density and/or morphologic difference consistent with activation were observed in microglia throughout MTD-exposed CC and cerebellum. Taken together, perinatal MTD exposure reveals global attenuation of myelination, accelerated apoptosis of both differentiated and myelinating oligodendrocytes, and microglia activation, supporting an association between antenatal MTD exposure and impaired myelination in the developing brain.

Risk factors for preterm birth among gravid individuals receiving buprenorphine for opioid use disorder

Opioid use disorder (OUD) has dramatically increased over the last few decades, with 11.5 million American misusing opioids in 2016. Untreated OUD in pregnancy is associated with unique adverse obstetric and perinatal outcomes including insufficient prenatal care, preterm birth (PTB), fetal growth restriction, fetal demise, and placental abruption . The mainstay treatment for OUD management in pregnancy is medication for opioid use disorder (MOUD) including methadone or buprenorphine. The association of PTB and opioid use in pregnancy has been described for over 50 years, and efforts to significantly eliminate this risk are challenged by the many confounding risks described above. When comparing rates of PTB in individuals with OUD on methadone vs buprenorphine. Buprenorphine has been associated with overall lower PTB than Methadone by almost 50 %. Pregnancies complicated by opioid use disorder are at an increased risk for preterm birth, defined as delivery <37 weeks' gestation. Limited literature is available on the prevalence and risk factors for preterm birth in pregnancies complicated by opioid use disorder maintained on buprenorphine. Therefore, we sought to determine the rate of preterm birth and risk factors for preterm birth in this population. We performed a retrospective cohort study of pregnant individuals with singleton gestations receiving buprenorphine for opioid use disorder, who delivered at a tertiary academic medical center between July 1, 2013 and June 30, 2018. Individuals who had at least 3 visits to our colocated clinic were included in the analysis. Patients were divided into 2 groups: the preterm group for patients who delivered at <37 weeks of gestation and the term group for those who delivered at ≥37 weeks of gestation. We defined "supplements to buprenorphine" to include any illicit drugs found on antepartum urine toxicology. Variables evaluated as potential risk factors for preterm birth included medical and infectious comorbidities and illicit polysubstance use. The overall preterm birth rate in this cohort was 22.7% (115/507). There was a nonsignificant trend toward decrease in overall preterm birth and provider-initiated preterm birth rate over the study period. No differences were found between the groups in spontaneous preterm birth rate at <34 weeks of gestation. There were no differences between the groups in the use of tobacco or alcohol, number of prenatal visits, or gestational age when prenatal care started. Individuals with preterm birth in the index pregnancy were more likely to have a history of preterm birth than individuals with term delivery (73% vs 16%; P<.01). No medical or infectious comorbidity or any specific supplement increased the risk of preterm birth. Among individuals using 0, 1, 2, or 3 or more illicit supplements in addition to confirmed buprenorphine for opioid use disorder, the preterm birth rate was 27.4% (reference), 18.0% (P=.09), 18.1% (P=.44), and 15.8% (P=.77), respectively. The preterm birth rate among individuals using buprenorphine for opioid use disorder (22.7%) is higher than the national average but lower than the reported preterm birth rate in individuals using methadone for the treatment of opioid use disorder. No medical or infectious comorbidity or use of additional illicit substances increased the risk of preterm birth.

Treatment of Opioid Use Disorder in Pregnancy Improves Outcomes

Source: Piske M, Homayra F, Min JE, et al. Opioid use disorder and perinatal outcomes. Pediatrics. 2021;148(4):e2021050279. doi: 10.1542/peds.2021-050279Investigators from multiple institutions in Canada conducted a retrospective study to evaluate perinatal outcomes in infants born to mothers with opioid use disorder (OUD). For the study, they linked multiple databases to identify mothers with OUD diagnosed before delivery or in the puerperium period with completed pregnancies between April 1, 2000 and March 31, 2019 in British Columbia, Canada. Data abstracted on mothers included age, parity, gestational age, receipt of opioid agonist treatment, timing of treatment (before pregnancy, during pregnancy but not until delivery, or until delivery), type of opioid agonist treatment (methadone, slow release oral morphine [SROM], buprenorphine/naloxone), use of other psychotropic drugs during pregnancy (selective serotonin reuptake inhibitors [SSRIs], benzodiazepines, antipsychotics, and stimulants), tobacco use, and alcohol use. Newborn outcomes included low birth weight (<2,500 g), prematurity (<37 weeks), and neonatal abstinence syndrome (NAS) diagnosis (based on ICD-9 and ICD-10 codes). Descriptive statistics were used to evaluate these outcomes and assess trends over the study period. Linear mixed effects models were used to compare outcomes in babies whose mothers used opioid agonist treatment until delivery and in those who discontinued treatment in pregnancy, and in mothers treated with buprenorphine/naloxone or SROM vs methadone. Models were adjusted for maternal age, parity, use of psychotropic drugs, and alcohol and tobacco use.A total of 4,574 women were diagnosed with OUD, with 6,693 deliveries and 6,720 live births during the study period. Opioid agonist treatment during pregnancy was documented for 2,824 deliveries (42%), and prescriptions for psychotropic drugs were identified during pregnancy in 2,684 (37%) deliveries. During the study period, the number of cases of OUD in pregnancy increased from 166 in 2000–2001 to 513 in 2018–2019. Rates of use of opioid agonist treatment remained stable during the treatment period; 94.7% of opioid agonist treatment was with methadone. Among the infants born to mothers with OUD, 16% were low birth weight, 24% were born premature, and 2,496 (36.8%) were diagnosed with NAS. In the multivariate models, continued opioid agonist treatment through delivery, compared to treatment discontinuation during pregnancy, was associated with an increased risk of NAS in the infant (odds ratio [OR], 4.7; 95% CI, 3.6, 6.1), but decreased risk of preterm birth (OR, 0.6; 95% CI, 0.4, 0.8) and low birth weight (OR, 0.4; 95% CI, 0.2, 0.7). Compared to methadone, treatment with buprenorphine/naloxone or SROM was associated with lower risks of preterm delivery (OR, 0.6; 95% CI, 0.3, 0.9), low birth weight (OR, 0.6; 95% CI, 0.4, 0.9) and NAS (OR, 0.6; 95% CI, 0.4, 0.9).The authors conclude the incidence of perinatal OUD in British Columbia more than tripled over a 20-year period.Dr Von Kohorn has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The documented increases in OUD during pregnancy and NAS in Canada mirror the US experience, where a recent national estimate of OUD in pregnancy was 8.2 per 1,000 births, and NAS was 7.3 per 1,000 births.1 (See AAP Grand Rounds. 2018;39[4]:47.)2 The current investigators found a rate of prematurity of 24% among infants born to mothers with OUD, which is more than double the population rate in the US.3 In multivariate models the authors demonstrate that treatment with opioid agonists, particularly non-methadone medications, significantly and substantially was associated with a reduced chance of prematurity.Despite the increase in OUD during pregnancy, the results of the current study show that the proportion of pregnant women with OUD who receive treatment remains stable and low, with less than half receiving opioid agonist treatment. The results of prior studies have shown similarly poor rates of opioid agonist treatment, with even less behavioral therapy.4 One barrier to uptake or continuation of opioid agonist treatment during pregnancy has been doubt about the strength of the evidence for improved outcomes with opioid agonist treatment during pregnancy. The current study overcomes many limitations of prior studies, and the results substantiate the association of opioid agonist treatment for those with OUD in pregnancy with improved outcomes.The evidence presented reinforces the need to make opioid agonist therapy more accessible to pregnant women with OUD. Since more than 90% of participants in the current study also had a coexisting mental health and other substance use diagnosis, interventions that increase holistic, multidisciplinary treatment may be optimal. Despite growing evidence for the superiority of buprenorphine and other non-methadone medications, methadone remains a common treatment.5 Improved access to non-methadone medications can help increase uptake.4OUD in pregnancy has increased substantially. Although treatment with opioid agonist medications improves outcomes, the proportion of those receiving treatment during pregnancy remains low.

Treatment access for opioid use disorder in pregnancy among rural and American Indian communities

BackgroundOpioid use disorder (OUD) in pregnancy disproportionately impacts rural and American Indian (AI) communities. With limited data available about access to care for these populations, this study's objective was to assess clinic knowledge and new patient access for OUD treatment in three rural U.S. counties. Material and methodsThe research team used unannounced standardized patients (USPs) to request new patient appointments by phone for white and AI pregnant individuals with OUD at primary care and OB/GYN clinics that provide prenatal care in three rural Utah counties. We assessed a) clinic familiarity with buprenorphine for OUD; b) appointment availability for buprenorphine treatment; c) appointment wait times; d) referral provision when care was unavailable; and e) availability of OUD care at referral locations. We compared outcomes for AI and white USP profiles using descriptive statistics. ResultsThe USPs made 34 calls to 17 clinics, including 4 with publicly listed buprenorphine prescribers on the Substance Abuse and Mental Health Services Administration website. Among clinical staff answering calls, 16 (47%) were unfamiliar with buprenorphine. OUD treatment was offered when requested in 6 calls (17.6%), with a median appointment wait time of 2.5 days (IQR 1–5). Among clinics with a listed buprenorphine prescriber, 2 of 4 (50%) offered OUD treatment. Most clinics (n = 24/28, 85.7%) not offering OUD treatment provided a referral; however, a buprenorphine provider was unavailable/unreachable 67% of the time. The study observed no differences in appointment availability between AI and white individuals. ConclusionsRural-dwelling AI and white pregnant individuals with OUD experience significant barriers to accessing care. Improving OUD knowledge and referral practices among rural clinics may increase access to care for this high-risk population.

Caring for Parturients with Substance Use Disorders.

Parturients with substance use disorder require expertise to manage the complexity of intoxication, withdrawal, and chronic use as well as ensure adequate analgesia throughout labor. Opioid use disorder in pregnancy has increased more than 4-fold in the past decade, with a 50-fold geographic variability that now dwarfs other substance use in this population. Understanding not only the medical but also the public health and criminal justice implications of substance use disorder is essential to providing optimal care to this at-risk population.

Impact of cuddler service-learning program in medical student education of opioid use disorder in pregnancy and neonatal opioid withdrawal syndrome

Background: Given the increasing incidence of neonatal opioid withdrawal syndrome (NOWS), medical student training on substance use disorders (SUDs) and opioid use disorder (OUD) in pregnancy must be augmented. Through the Cuddling Assists in Lowering Maternal and Infant Stress (CALM) service-learning program, medical students attend SUD-related didactics and provide monthly cuddling services to infants with NOWS. Objective: This study examines the impact of CALM on medical students’ attitudes toward individuals with SUDs and self-reported comfort with clinical skills related to caring for this population. Methods: Self-reported pre- and post-survey data was collected at the beginning and end of an academic year from the intervention group, CALM cuddlers, and the control group, non-cuddlers for 2 years. Mean total survey scores and individual survey questions using a 3-point Likert scale were compared before and after 1 year of participation for cuddlers and for non-cuddlers using paired t-tests and two sample t-tests. Results: The mean total score increased for cuddlers after participation in the intervention (MD 0.13, SD 0.26, p = 0.03). Mean scores for the comfort-related subset of questions also increased significantly for cuddlers after participation in the intervention (MD 0.22, SD 0.41, p = 0.01). Cuddlers felt more comfortable discussing substance use with appropriate language (72.0% vs 51.5%, p = 0.03), talking with patients about substance use (72.0% vs 36.0%, p = 0.01), and asking about substance use or recovery (80.0% vs 48.0%, p = 0.01). Conclusion: OUD- and NOWS-related service-learning positively impacts student attitudes and self-reported comfort with skills related to caring for individuals with SUDs, such as communicating about substance use.

Use of Methadone Maintenance Therapy for Opioid Use Disorder in Pregnancy.

Use of Methadone Maintenance Therapy for Opioid Use Disorder in Pregnancy.

Home Induction of Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy.

Home Induction of Buprenorphine for Treatment of Opioid Use Disorder in Pregnancy.

Nail disease in neonatal abstinence syndrome.

Neonatal abstinence syndrome (NAS) incidence continues to rise in the United States due to increasing opioid use disorder in pregnancy. While cutaneous excoriations have been noted in NAS, there is a paucity of literature regarding abnormal nail findings in NAS. A retrospective, observational case series was conducted of twelve patients with NAS and abnormal nail findings who were admitted to the neonatal intensive care unit between January 1, 2018, and May 1, 2020. Twelve neonates (10 male, 2 female, mean gestational age at birth 38.1weeks) with NAS diagnosis and abnormal nail findings were identified between January 1, 2018, and May 1, 2020. NAS was diagnosed by elevated Modified Finnegan Neonatal Abstinence Syndrome Tool (M-FNAST) scores. All patients required pharmacologic treatment for NAS with seven (58.3%) requiring phenobarbital in addition to first-line morphine. Common nail findings included periungual erythema, yellow crusting, desquamation of the proximal and/or distal lateral nail folds and sheared distal nail edges. Two patients (16.7%) required antibiotic treatment for paronychia. Peak M-FNAST scores were positively correlated with number of abnormal nail findings (r=.58, P=.047). Twelve neonates with severe NAS demonstrated similar nail abnormalities, likely secondary to NAS agitation and motor hyperactivity. Nail exams, therefore, are important in the setting of suspected or confirmed NAS to limit continued nail trauma and infection. Our findings also introduce an association between NAS severity and abnormal nail findings, which will require larger studies for further confirmation.

Buprenorphine Patch as a Bridge to Sublingual Treatment of Opioid Use Disorder in Pregnancy.

Buprenorphine Patch as a Bridge to Sublingual Treatment of Opioid Use Disorder in Pregnancy.

Opioid use disorder in pregnancy: leveraging provider perceptions to inform comprehensive treatment

BackgroundMedications for opioid use disorder (MOUD) are recommended with adjuvant behavioral therapies, counseling, and other services for comprehensive treatment of maternal opioid use disorder. Inadequate access to treatment, lack of prescribing providers and complex delivery models are among known barriers to care. Multi-disciplinary provider input can be leveraged to comprehend factors that facilitate or inhibit treatment. The objective of this study is to explore provider perceptions of MOUD and factors critical to comprehensive treatment delivery to improve the care of pregnant women with opioid use disorder.MethodsA qualitative research approach was used to gather data from individual provider and group semi-structured interviews. Providers (n = 12) responded to questions in several domains related to perceptions of MOUD, treatment delivery, access to resources, and challenges/barriers. Data were collected, transcribed, coded (by consensus) and emerging themes were analyzed using grounded theory methodology.ResultsEmerging themes revealed persistent gaps in treatment and challenges in provider, health systems and patient factors. Providers perceived MOUD to be a “lifeline” to women.ConclusionsInconsistencies in treatment provision, access and uptake can be improved by leveraging provider perceptions, direct experiences and recommendations for an integrated team-based, patient-centered approach to guide the care of pregnant women with opioid use disorder.

59473 Clinical and demographic predictors of the need for pharmacotherapy in Neonatal Abstinence Syndrome (NAS)

ABSTRACT IMPACT: This work has the potential to help clinicians decide which infants exposed to in utero opioids, will need to be treated early or can be discharged home early based on their risk, thus reducing prolonged hospitalization OBJECTIVES/GOALS: To develop and validate a prediction model with inclusion of clinical and demographic risk factors to identify infants with NAS likely to need pharmacotherapy. METHODS/STUDY POPULATION: A pooled cohort of 761 infants from 5 different studies including 2 trials and 3 observational cohorts will be used to develop the model.All infants &gt;than or equal to 37 weeks gestational age born to mothers with history of OUD will be included. Infants with congenital disorders and severe medical and surgical illnesses will be excluded. Multivariable mixed effects logistic regression modeling will be performed to predict the need for pharmacologic treatment for NAS. Candidate variables will be included based on clinical knowledge and previously published data. Model performance will be evaluated by measuring discrimination using Area Under the Curve (AUC) statistics and calibration. Model will be internally validated using boot strap validation. RESULTS/ANTICIPATED RESULTS: Pending data analysis DISCUSSION/SIGNIFICANCE OF FINDINGS: Opioid Use Disorder in pregnancy has resulted in concurrent rise in NAS incidence. NAS affects opioid exposed infants variably and accurate prediction of its severity and need for treatment remains elusive. Known clinical and demographic factors can predict the need for NAS therapy in opioid exposed infants, aiding clinical decision making.