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Substance Abuse during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Naltrexone has been used to treat several substance dependencies during pregnancy without apparent untoward effects, but no long-term follow-up studies have been published (Hulse et al., 2001). An alternative therapy with little or no potential for abuse is buprenorphine/naloxone (Suboxone), but there are no studies of its use during pregnancy. Disulfiram (Antabuse), a deterrent for alcohol abuse, should not be used at any time during pregnancy because of its strong copper-chelating properties. Copper is essential to normal fetal neuronal formation and migration, and any impediment in these processes may result in fetal brain malformations. Notably, this is a theoretical risk.
Biological Approaches
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Tricia L. Chandler, Mary C. Hoke, Tara G. Matthews, Elizabeth Reyes-Fournier
Buprenorphine-Naloxone, sold under the brand name Suboxone, is a partial opioid agonist that is the most commonly prescribed MAT for opioid use disorder (Connery, 2015). Suboxone is not as effective at long-term sobriety maintenance as methadone; however, there is little to no chance of an individual overdosing with this medication, and it is still considered a better choice for those at high risk of relapse and/or those with health issues (Srivastava et al., 2017). Unlike methadone, which is dispensed directly by the medical provider one dose at a time, suboxone is dispensed by prescription. This poses the issue that the individual is not required to attend any form of behavioral counseling services, which are still considered to be the most effective treatment (Connery, 2015).
Substance Use Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Suboxone is a combination of buprenorphine and naltrexone in a 4:1 ratio. The addition of naltrexone is meant to deter parenteral use and lowers the risk of diversion. Previous guidelines recommended use of the buprenorphine monoproduct during pregnancy due to the theoretical risk of naloxone exposure and withdrawal from misuse. A recent systematic review (n=5 studies, 291 buprenorphine-naloxone exposed dyads) demonstrated similar pregnancy outcomes compared to other MOUD [102]. As additional data becomes available supporting the safety of the combination product, its use during pregnancy is likely to continue to increase. There is no reason to preferentially start a pregnant patient on the monoproduct or switch to the monoproduct in a patient previously stable on the combination product.
Attitudes and beliefs among Georgia addiction treatment staff about medication for opioid use disorder in adolescents, young adults, and adults: a multi-mixed methods study
Published in The American Journal of Drug and Alcohol Abuse, 2022
Justine W. Welsh, Maggie J. Mataczynski, Lora L. Passetti, Brooke D. Hunter, Mark D. Godley
Despite increased awareness and education surrounding MOUD, several barriers to its use were noted. If recommended, MOUD was considered acceptable under strictly defined parameters. Some responders expressed concerns about its potential for misuse by the client or his/her family members, in combination with other substances, overdose, and diversion. Withdrawal from MOUD was viewed as extremely problematic and significant enough to warrant avoidance of its use by some participants. These concerns are explained below. [M]ethadone and Bup. These are not helpful in the long run. It is harder to get off of them then the opiates they were using.Suboxone and methadone are addictive themselves and clients depend on that long-term. They are often more painful to detox from than the opiates themselves.
Methadone and suboxone® mentions on twitter: thematic and sentiment analysis
Published in Clinical Toxicology, 2021
Megan Chenworth, Jeanmarie Perrone, Jennifer S. Love, Rachel Graves, Whitney Hogg-Bremer, Abeed Sarker
The stigma theme encompassed tweets that alluded to the public’s negative view about MOUDs. Tweets in this theme directly referenced instances of feeling stigmatized or judged based on the use of MOUD as well as tweets that indirectly referenced the stigma by referring to the medication, its users, or objects related to the use of the medication (such as Suboxone® wrappers) in a negative light. Some tweets asserted the idea that using methadone or Suboxone® is simply “substituting one drug or addiction for another” and that abstinence from all opioids is the only acceptable goal for people with OUD. We categorized such tweets as “opioid substituting” (Tables 3 and 4). Methadone tweets also described situations where individuals experienced stigma from healthcare providers, while Suboxone® tweets mentioned stigma associated with myths (e.g., Suboxone® makes a person more violent), referenced the idea of a “suboxone addiction”, or mentioned addictive properties of Suboxone®.
Barriers to Buprenorphine Expansion in Ohio: A Time-Elapsed Qualitative Study
Published in Journal of Psychoactive Drugs, 2019
Todd Molfenter, Maureen Fitzgerald, Nora Jacobson, Dennis McCarty, Andrew Quanbeck, Mark Zehner
Concerns regarding buprenorphine diversion were strong among the boards in both the 2012/13 and 2015 data collections. They did not want to be perceived as contributing to their community’s illicit drug problem. One board reported, “We know there’s a lot of diversion going on out there but that looks bad on us even though we got stricter guidelines about how we deliver [buprenorphine] to the patient.” Moreover, the boards believed that diverted medication often originated from cash-based medical practices that do not follow the buprenorphine diversion prevention policies. A board member explained, “The thing is diversion isn’t coming from our funded programs. It’s coming from the for-profit docs out in the community.” Boards “want[ed] to make sure that any referrals are going to providers that are working directly with our agencies.” In 2015, boards perceived increased diversion concerns among community stakeholders: Law enforcement, prosecuting attorneys, and some judges are not supportive of using Suboxone® because they see the misuse and that concerns them.The public as well as local law enforcement was having issues with it (Suboxone®) being sold on the street, diversion, and those kinds of things.