2.12 IMPACT OF PERINATAL OPIOID USE VERSUS POLYDRUG USE ON NEONATAL WITHDRAWAL SYMPTOMS: A COMPARISON STUDY OF EXPOSED INFANTS WITH NONEXPOSED GROUP

Abstract Introduction Maintaining abstinence through the opioid withdrawal period is a substantial barrier to treatment for patients with opioid use disorder. The alpha-2 agonist lofexidine has demonstrated efficacy and safety in clinical trials, but pragmatic studies describing its use in clinical practice are lacking. This case series describes the use of lofexidine for opioid withdrawal symptoms in an inpatient addiction treatment facility. Methods Seventeen patients receiving at least 1 dose of lofexidine during inpatient treatment for opioid withdrawal were included in this study. A retrospective chart review was conducted for clinical, subjective, and objective data. Adverse events, total daily dose, clinical opioid withdrawal scale (COWS) scores, vital signs, and reasons for early discontinuation of lofexidine are reported. Results Patients treated with lofexidine experienced mild withdrawal symptoms throughout treatment. Most patients (65%) experienced a decrease in their average daily COWS scores from intake to discharge. Two patients (12%) left treatment against medical advice, and 5 patients (29%) discontinued treatment prior to day 7 due to resolution of symptoms. Average daily blood pressure readings remained stable, and daily average heart rate decreased over time. Discussion Lofexidine can be successfully incorporated into a conventional withdrawal management protocol. The cost of lofexidine and its recent introduction to the market remain barriers to accessibility in the United States. Studies evaluating patient-reported outcomes as well as direct comparisons with other alpha-2 agonists are needed to inform optimal clinical use of lofexidine.

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Fetal Addiction to Pentazocine

PEDIATRICS ◽

10.1542/peds.55.6.888 ◽

1975 ◽

Vol 55 (6) ◽

pp. 888-889

Author(s):

Arthur E. Kopelman

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Urinary Tract Infection ◽

Case Report ◽

Sickle Cell ◽

Withdrawal Symptoms ◽

Sickle Hemoglobin ◽

Severe Withdrawal ◽

Sickle Cell Crises ◽

Neonatal Withdrawal

A case of neonatal withdrawal symptoms following maternal use of pentazocine was recently reported.1 This is the report of a second case with severe withdrawal symptoms which were successfully treated with phenobarbital. CASE REPORT A 2,180-gm, small-for-date, black female infant was delivered by cesarean section at 37 weeks' gestation. The mother, a 26-year-old gravida 3, para 0 woman with sickle cell anemia, had several painful sickle cell crises, congestive heart failure, pneumonia, and a urinary tract infection during this pregnancy. The two previous pregnancies had ended in abortion. In the second half of this pregnancy, she was treated with frequent packed-cell transfusions in order to decrease to less than 50% the number of her erythrocytes with sickle hemoglobin and hence the risk of clinical sickling.

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The impact of preoperative opioid use on outcomes after elective colorectal surgery: A propensity-matched comparison study

Surgery ◽

10.1016/j.surg.2019.07.010 ◽

2019 ◽

Vol 166 (4) ◽

pp. 632-638 ◽

Cited By ~ 2

Author(s):

Alexander R. Cortez ◽

Christopher M. Freeman ◽

Nick C. Levinsky ◽

Al-Faraaz Kassam ◽

Koffi Wima ◽

...

Keyword(s):

Colorectal Surgery ◽

Comparison Study ◽

Opioid Use ◽

Elective Colorectal Surgery ◽

Matched Comparison ◽

The Impact

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Does Opioid Maintenance Therapy Decrease the Risk of Neonatal Withdrawal in Mothers with Opioid Use Disorder? [28N]

Obstetrics and Gynecology ◽

10.1097/01.aog.0000533124.64418.cf ◽

2018 ◽

Vol 131 ◽

pp. 159S

Author(s):

Victoria Ly ◽

Malini D. Persad ◽

Kimberly Herrera ◽

David Garry ◽

Diana Garretto

Keyword(s):

Maintenance Therapy ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Maintenance Therapy ◽

Neonatal Withdrawal

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Sirt3 mediated by lentiviral vector in the periaqueductal gray suppresses morphine withdrawal in rats: A preliminary study

10.1101/743062 ◽

2019 ◽

Author(s):

Shue Liu ◽

Hyun Yi ◽

Jun Gu ◽

Daigo Ikegami ◽

Kentaro Hayashi ◽

...

Keyword(s):

Behavioral Response ◽

Molecular Mechanisms ◽

Lentiviral Vector ◽

Morphine Withdrawal ◽

Withdrawal Symptoms ◽

Opioid Use ◽

Chronic Morphine ◽

Mitochondrial Energy Metabolism ◽

Preliminary Study ◽

Novel Therapeutic

AbstractOpioid use disorder (OUD) is a significant clinical and social problem, inducing dependence/addiction and over-dose death. Opioid dependence/withdrawal contributes to the addiction vulnerability. Limited understanding of the exact mechanisms of morphine withdrawal leads to failure to adequately manage opioid withdrawal symptoms. Determining new molecular mechanisms of morphine withdrawal (MW) may allow development of novel therapeutic strategies for treating this disorder. Chronic morphine with naloxone precipitation induces MW behavioral response. Sirt3 (one member of sirtuins family) as a mitochondrial fidelity, plays an important role in mitochondrial homeostasis through the direct regulation of mitochondrial energy metabolism, ATP synthesis, detoxification of mitochondrial ROS, etc. In the pilot study, we found that (1) cultured neurons infected with lentiviral vector expressing Sirt3 induced over-expression of Sirt3, (2) microinjection of LV-Sirt3 into the vlPAG increased Sirt3 protein expression in rats, (3) MW lowered the expression of Sirt3 in the vlPAG, and (4) microinjection of LV-Sirt3 into the vlPAG decreased the MW behavioral response. Current preliminary study demonstrates that complement of Sirt3 in the PAG suppressed MW, providing a novel therapeutic approach to morphine physical withdrawal symptoms. The exact up-and/or down-stream factors of Sirt3 in the model are under the investigation.

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