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Substance Use Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Opioid agonist therapy with either methadone or buprenorphine is the standard treatment for opioid use disorder. Replacement therapy diminishes the risks of obstetrical complications and increases utilization of prenatal care, among other benefits. The dose of medication is titrated to the lowest dose that effectively prevents withdrawal symptoms.
Low-Dose Naltrexone
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Ultra-low-dose naltrexone has been investigated as an adjunct to opioid agonist therapy for pain. The concept of using a low-dose naltrexone in combination with an opioid agonist is not new. In fact, there have been opioid agonist–antagonist combination drugs approved by the FDA, including Embeda® (morphine/naltrexone as 20 mg/0.8 mg, 30 mg/1.2 mg, 50 mg/2 mg, 60 mg/2.4 mg, 80 mg/3.2 mg, 100 mg/4 mg) and Troxyca ER® (oxycodone/naltrexone as 10 mg/1.2 mg, 20 mg/2.4 mg, 30 mg/3.6 mg, 40 mg/4.8 mg, 60 mg/7.2 mg, 80 mg/9.6 mg).26,27
Pharmacotherapies for PTSD and Substance Use Disorders
Published in Anka A. Vujanovic, Sudie E. Back, Posttraumatic Stress and Substance Use Disorders, 2019
Lorig K. Kachadourian, Kevin P. Jensen, Mehmet Sofuoglu, Ismene Petrakis
Treatments for opioid use disorder (OUD) include buprenorphine, methadone, and naltrexone. These treatments have demonstrated improvement in OUD over psychosocial treatments alone (see Management of Substance Use Disorders Workgroup, 2015). Naltrexone treatment is limited by poor client compliance and is found to be useful primarily in special populations, such as recovering physicians or clients who are required to remain drug free as a condition of probation or parole. Newer evidence with intramuscular naltrexone suggests that this formulation may be more effective than oral (e.g., Krupitsky et al., 2011). For most clients, the first line is opioid agonist therapy (OAT), which involves administering a medication, such as methadone or buprenorphine in combination with a range of medical, counseling, and rehabilitative services. By administering an opioid to prevent withdrawal, reduce craving, and reduce the effects of illicit opioids, greater attention can be spent on recovery activities. When compared to medically supervised withdrawal attempts, OAT is more successful in achieving long-term opioid use and the related negative medical, legal, and social consequences, including death from overdose (Management of Substance Use Disorders Workgroup, 2015).
Health-related quality of life in people receiving opioid agonist treatment and treatment for hepatitis C virus infection
Published in Journal of Addictive Diseases, 2023
Olav Dalgard, Alain H. Litwin, Oren Shibolet, Jason Grebely, Ronald Nahass, Frederick L. Altice, Brian Conway, Edward J. Gane, Anne F. Luetkemeyer, Cheng-Yuan Peng, David Iser, Isaias Noel Gendrano, Michelle M. Kelly, Barbara A. Haber, Heather Platt, Amy Puenpatom
Adults aged ≥18 years with HCV genotype 1, 4, or 6 infection and serum HCV RNA ≥10,000 IU/mL were enrolled. Participants were required to have received opioid agonist therapy for ≥3 months prior to screening and have kept ≥80% of scheduled appointments while on medication. Opioid agonist therapy included methadone, levomethadone, buprenorphine (alone or in combination with naloxone), or naltrexone. Participants were naive to previous treatment for HCV infection and had no cirrhosis (i.e., liver biopsy showing absence of cirrhosis with a FibroScan [Echosens, Paris, France] score ≤12.5 kPa or a FibroSure [LabCorp, Burlington, NC, USA] score ≤0.48 and an aspartate aminotransferase-to-platelet ratio index [APRI] of ≤1) or had compensated cirrhosis (liver biopsy showing cirrhosis with a FibroScan score of >12.5 kPa or a FibroSure score of >0.75 and an APRI of >2). Planned enrollment allowed for up to 20% of patients with compensated cirrhosis.11
Substance-related diagnosis type predicts the likelihood and co-occurrence of preterm and cesarean delivery
Published in Journal of Addictive Diseases, 2023
Natasia S. Courchesne-Krak, María Luisa Zúñiga, Christina Chambers, Mark B. Reed, Laramie R. Smith, Jerasimos Ballas, Carla Marienfeld
Findings from this study substantiate the previous findings of an increased risk for preterm delivery,8–10 but not cesarean delivery,10,20 in pregnant women who use opioids. This may be due to the regional variability associated with Southern California. Variance in these findings may also be related to differences in identifying pregnant women with an ICD-10 code for an opioid-related diagnosis (i.e., use, misuse, or dependence) compared to using a clinical assessment that requires a formal diagnosis per the DSM-5 to identify an opioid use disorder (OUD), which is a type of opioid-related diagnosis. Differences in these findings may also be related to the unmeasured and unknown impact of opioid agonist therapy (e.g., methadone) on delivery outcomes. Interestingly, an opioid-related diagnosis remained significantly associated with co-occurring preterm and cesarean delivery. This indicates that the strength of the relationship between opioid use and preterm delivery may be driving this observed association.
Case report: rapid inpatient methadone titration during pregnancy
Published in Journal of Substance Use, 2022
In the current case report, we have described a rapid inpatient methadone titration during pregnancy. To our knowledge, this has not been described elsewhere in the literature. Pregnant women with severe opioid use disorder are at high risk of negative maternal–fetal outcomes including overdose during pregnancy and in the postnatal period, necessitating a mechanism for rapid stabilization on opioid agonist therapy. Current methadone guidelines are designed to minimize the risk of methadone overdose during the titration period by allowing for serum levels to reach steady state at a given dose prior to further titration. This approach frequently leaves the patient at subtherapeutic methadone doses for long periods of time and therefore is in many circumstances associated with continued risk of overdose related to ongoing illicit opioid use. We believe methadone can be titrated more rapidly in the inpatient setting by utilizing small, split doses of methadone and careful observation.