Opioid maintenance treatment of pregnant women in the Scandinavian countries

Background: WHO guidelines emphasise the need for descriptions of clinical practice and observational studies on risk and benefits of pharmacotherapies in pregnancy. The aims of the present study were to: (1) Describe opioid maintenance treatment (OMT) in the Scandinavian countries in general, and specifically for pregnant women, (2) Describe a project which utilises a new approach using registry-linkage data to examine associations between prenatal exposure to OMT and child outcomes: a Scandinavian cohort study of pregnant women in OMT during pregnancy (ScopeOMT). Data: Guidelines describing the treatment of persons with opioid use disorders in general, and specifically for pregnant women. Scandinavian registry-linkage data from ScopeOMT. Results: Registry data show that approximately 800 pregnant women received OMT during pregnancy in the period of the ScopeOMT study. Similarities across the Scandinavian countries include access to free healthcare and treatment; multidisciplinary teams trained to support pregnant women in OMT; buprenorphine as the recommended drug when initiating therapy; and a holistic focus on the patients’ lives. An important difference is that Norwegian women who use illegal substances that may harm the foetus may be admitted – voluntarily, or against their will – for parts of, or the remainder of the pregnancy to inpatient treatment at specialised clinics. Conclusion: Many similarities in the treatment provided to opioid-dependent persons in the Scandinavian countries place this area in an excellent position to combine the efforts and carry out observational studies concerning the safety of OMT during pregnancy.

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When treating pregnant women with opioid use disorder, the benefits of using opioid maintenance treatment outweigh the risks

Drugs & Therapy Perspectives ◽

10.1007/s40267-016-0281-x ◽

2016 ◽

Vol 32 (5) ◽

pp. 186-190

Author(s):

Keyword(s):

Pregnant Women ◽

Maintenance Treatment ◽

Opioid Use Disorder ◽

Opioid Use ◽

Opioid Maintenance Treatment

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Birth and Neonatal Outcomes following Opioid Use in Pregnancy: A Danish Population-Based Study

Substance Abuse Research and Treatment ◽

10.4137/sart.s23547 ◽

2015 ◽

Vol 9s2 ◽

pp. SART.S23547 ◽

Cited By ~ 6

Author(s):

Mette Nørgaard ◽

Malene Schou Nielsson ◽

Uffe Heide-Jørgensen

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Congenital Malformations ◽

Maintenance Treatment ◽

Population Based ◽

Adverse Birth Outcomes ◽

Opioid Use ◽

Opioid Maintenance Treatment ◽

Opioid Substitution Treatment ◽

Gestational Week

Background Few population-based data exist on birth outcomes in women who received opioid maintenance treatment during pregnancy. We therefore examined adverse birth outcomes in women exposed to methadone or buprenorphine during pregnancy and the risk of neonatal abstinence syndrome (NAS) among neonates exposed to buprenorphine, methadone, and/or heroin in utero. Patients and Methods This study included all female Danish residents with a live birth or a stillbirth from 1997 to 211. We identified the study population, use of opioids and opioid substitution treatment, birth outcomes, and NAS through medical registers. Birth outcomes included preterm birth (born before 38th gestational week), low-birth weight (LBW) (<2,500 g, restricted to term births), small for gestational age (SGA) (weight <2 standard deviations from the sex- and gestational-week-specific mean), congenital malformations, and stillbirths. We used log-binomial regression to estimate the prevalence ratio (PR) for birth outcomes. Results Among 95,172 pregnancies in a total of 571,823 women, we identified 557 pregnancies exposed to buprenorphine, methadone, and/or heroin (167 to buprenorphine, 197 to methadone, 28 to self-reported heroin, and 165 to combinations). Compared with nonexposed pregnancies, prenatal opioid use was associated with greater prevalence of preterm birth (PR of 2.8 (95% confidence interval (CI), 2.3–3.4)), LBW among infants born at term (PR of 4.3 (95% CI, 3.0–6.1)), and being SGA (PR of 2.7 (95% CI, 1.9–4.3)). Restricting the analyses to women who smoked slightly lowered these estimates. The prevalence of congenital malformations was 8.3% in opioid-exposed women compared with 4.2% in nonexposed women (PR of 2.0 (95% CI, 1.5–2.6)). The risk of NAS ranged from 7% in neonates exposed to buprenorphine only to 55% in neonates exposed to methadone only or to opioid combinations. Conclusion The maternal use of buprenorphine and methadone during pregnancy was associated with increased prevalence of adverse birth outcomes, and this increase could only be explained to a smaller extent by increased prevalence of smoking. The risk of NAS was eight-fold higher in methadone-exposed neonates than that in buprenorphine-exposed neonates, but this difference may at least partly be explained by differences in underlying indications (analgesic versus opioid maintenance treatment) between the two groups.

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Aerobic Exercise Interventions for Patients in Opioid Maintenance Treatment: A Systematic Review

Substance Abuse Research and Treatment ◽

10.1177/1178221820918885 ◽

2020 ◽

Vol 14 ◽

pp. 117822182091888

Author(s):

Danielle E Jake-Schoffman ◽

Meredith S Berry ◽

Marissa L Donahue ◽

Demetra D Christou ◽

Jesse Dallery ◽

...

Keyword(s):

Physical Activity ◽

Aerobic Exercise ◽

Maintenance Treatment ◽

Exercise Intervention ◽

Adjunctive Treatment ◽

Bibliographic Databases ◽

Opioid Use ◽

Opioid Maintenance Treatment ◽

Exercise Interventions ◽

Supervised Exercise

Background: Opioid maintenance treatment (OMT) is the standard for treatment of opioid use disorder, but some individuals on OMT experience disrupted sleep, heightened sensitivity to pain, and continued relapse to non-medical opioid use. An adjunctive treatment that has potential to address these shortcomings of OMT is aerobic exercise. Objective: The aim of the present review was to identify and evaluate components of aerobic exercise interventions targeting OMT patients. Methods: For this PROSPERO-registered review (ID CRD42020139626), studies were identified via electronic bibliographic databases, funded research ( NIH RePORTER) and clinical trials databases ( ClinicalTrials.gov), and reference sections of relevant manuscripts. Studies that evaluated the effects of an aerobic exercise intervention using a comparison condition or pretest-posttest design in adult OMT patients were included. Results: Of 2971 unique records, three primary studies and one supplemental manuscript comprised the final sample. All studies were randomized trials involving supervised exercise interventions enrolling small samples of middle-aged OMT patients. Exercise interventions included a variety of aerobic and non-aerobic activities (e.g. flexibility exercises), and none controlled the dose of aerobic exercise. Few studies used objective measures of physical activity or cardiorespiratory fitness and there were no significant effects of adjunctive exercise on substance use outcomes, but tests of the latter were likely underpowered. Conclusions: Though early in the accumulation of evidence, interventions targeting aerobic exercise for OMT patients appear feasible, acceptable to patients, and beneficial. Longer-term studies that employ larger samples, include assessments of behavioral and biological mechanisms of change, more rigorous measurement of physical activity, and controlled doses of aerobic activity are warranted.

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A 2-year prospective study of psychological distress among a national cohort of pregnant women in opioid maintenance treatment and their partners

Journal of Substance Use ◽

10.3109/14659891.2011.642928 ◽

2012 ◽

Vol 18 (2) ◽

pp. 148-160 ◽

Cited By ~ 7

Author(s):

Ingunn Olea Lund ◽

Svetlana Skurtveit ◽

Monica Sarfi ◽

Brittelise Bakstad ◽

Gabrielle Welle-Strand ◽

...

Keyword(s):

Psychological Distress ◽

Prospective Study ◽

Pregnant Women ◽

Maintenance Treatment ◽

Opioid Maintenance Treatment ◽

National Cohort

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Prescription drug use among pregnant women in opioid Maintenance Treatment

Addiction ◽

10.1111/j.1360-0443.2012.04049.x ◽

2012 ◽

Vol 108 (2) ◽

pp. 367-376 ◽

Cited By ~ 17

Author(s):

Ingunn Olea Lund ◽

Svetlana Skurtveit ◽

Anders Engeland ◽

Kari Furu ◽

Edle Ravndal ◽

...

Keyword(s):

Drug Use ◽

Pregnant Women ◽

Prescription Drug ◽

Maintenance Treatment ◽

Opioid Maintenance Treatment ◽

Prescription Drug Use

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Substance use during and after pregnancy among a national cohort of pregnant women in opioid maintenance treatment and their partners

Journal of Substance Use ◽

10.3109/14659891.2011.580415 ◽

2011 ◽

Vol 17 (3) ◽

pp. 277-286 ◽

Cited By ~ 12

Author(s):

Ingunn Olea Lund ◽

Svetlana Skurtveit ◽

Monica Sarfi ◽

Brittelise Bakstad ◽

Gabrielle Welle-Strand ◽

...

Keyword(s):

Substance Use ◽

Pregnant Women ◽

Maintenance Treatment ◽

Opioid Maintenance Treatment ◽

National Cohort

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Opioid use disorder in Germany: healthcare costs of patients in opioid maintenance treatment

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-019-0247-9 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Jens Reimer ◽

Tobias Vogelmann ◽

Daniel Trümper ◽

Norbert Scherbaum

Keyword(s):

Healthcare Costs ◽

Maintenance Treatment ◽

Hospital Costs ◽

Opioid Use Disorder ◽

Cost Driver ◽

Health Claims ◽

Opioid Use ◽

Opioid Maintenance Treatment ◽

Health Claims Data ◽

The Cost

Abstract Background Opioid Use Disorder (OUD) is a substance use disorder with a chronic course associated with comorbid mental and somatic disorders, a high burden of psychosocial problems and opioid maintenance treatment (OMT) as a standard treatment. In the US, OUD imposes a significant economic burden on society, with annual societal costs estimated at over 55 billion dollars. Surprisingly, in Europe and especially in Germany, there is currently no detailed information on the healthcare costs of patients with OUD. The goal of the present research is to gather cost information about OUD patients in OMT with a focus on maintenance medication and relapses. Methods We analysed health claims data of four million persons covered by statutory health insurance in Germany, applying a cost-of-illness approach and aimed at examining the direct costs of OMT patients in Germany. Patients with an ICD-10 code F11.2 and at least one claim of an OMT medication were stratified into the treatment groups buprenorphine, methadone or levomethadone, based on the first prescription in each of the follow-up years. Costs were stratified for years with and without relapses. Group comparisons were performed with ANOVA. Results We analysed 3165 patient years, the total annual sickness funds costs were on average 7470 € per year and patient. Comparing costs of levomethadone (8400 €, SD: 11,080 €), methadone (7090 €, SD: 10,900 €) and buprenorphine (6670 €, SD: 7430 €) revealed significant lower costs of buprenorphine compared to levomethadone (p < 0.0001). In years with relapses, costs were higher than in years without relapses (8178 € vs 7409 €; SD: 11,622, resp. 10,378 €). In years with relapses, hospital costs were the major cost driver. Conclusions The present study shows the costs of OUD patients in OMT for the first time with a German dataset. Healthcare costs for patients with an OUD in OMT are associated with more than two times the cost of an average German patients. Preventing relapses might have significant impact on costs. Patients in different OMT were dissimilar which may have affected the cost differences.

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An 11-year nationwide registry-linkage study of opioid maintenance treatment in pregnancy in Norway

Norsk Epidemiologi ◽

10.5324/nje.v29i1-2.4047 ◽

2021 ◽

Vol 29 (1-2) ◽

Author(s):

Ingvild Odsbu ◽

Milada Mahic ◽

Svetlana Skurtveit ◽

Ingunn-Olea Lund ◽

Marte Handal

Keyword(s):

Cohort Study ◽

General Population ◽

Pregnant Women ◽

Maintenance Treatment ◽

Adverse Outcomes ◽

Prescription Database ◽

Opioid Maintenance Treatment ◽

Clinical Cohort ◽

The Mean ◽

In Pregnancy

Aim: We aimed to describe opioid maintenance treatment (OMT) to pregnant women in Norway and study thebackground characteristics of the pregnant women compared to the general population of pregnant women andto a previous clinical cohort study of OMT in pregnancy.Methods: Population-based cohort study with linked data from the Norwegian Medical Birth Registry, theNorwegian Prescription Database, the Norwegian Patient Registry, and Statistics Norway. The study populationconsisted of women giving birth between 2005-2015 in Norway. We defined OMT pregnancies as pregnancieswhere the woman was dispensed OMT medications (methadone, buprenorphine, or buprenorphine/naloxone) at least once during pregnancy.Results: The study population consisted of 420,808 women with 645,440 pregnancies ending in a live birth inNorway in 2005-2015 (the general pregnant population). Of these, 261 women (0.6‰) had altogether 306OMT pregnancies. The mean number of pregnancies was 28 OMT pregnancies per year and quite stable duringthe study period. Women with OMT pregnancies were older, smoked tobacco more frequently, had lowereducation, and fewer of them had a partner, compared to the general population of pregnant women. In mostpregnancies, the women were treated with buprenorphine (n=183 (59.8%)), while in 120 (39.2%) pregnancies,the woman received methadone. From 2008, buprenorphine replaced methadone as the most frequently useddrug. In only 38 (12.4%) pregnancies, OMT treatment was initiated in pregnancy. In 201 (66%) pregnancies,the woman used OMT medications in all trimesters. For these women, the mean amount of dispensed drug was3.4 DDD/day (85 mg/day) in pregnancy for methadone and 1.9 DDD/day (15.2 mg/day) for buprenorphine.Conclusion: The number of OMT pregnancies per year has been low and stable in the period 2005-2015.Following Norwegian recommendations, there has been a shift from treatment with methadone towardsbuprenorphine. The women receiving OMT during pregnancy had more risk factors for adverse outcomes thanthe general pregnant population but were quite similar to the previous clinical cohort.

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Intact responses to non-drug rewards in long-term opioid maintenance treatment

10.31234/osf.io/v9zak ◽

2018 ◽

Author(s):

Marie Eikemo ◽

Philipp Paul Lobmaier ◽

Mads Lund Pedersen ◽

Nikolaj Kunøe ◽

Anna Maria Matziorinis ◽

...

Keyword(s):

Drug Use ◽

Psychosocial Stress ◽

Maintenance Treatment ◽

Comparison Group ◽

Computational Modelling ◽

Reward Processing ◽

Opioid Use ◽

Opioid Maintenance Treatment ◽

Reward Responsiveness

Disruption of non-drug reward processing in addiction could stem from long-term drug use, addiction-related psychosocial stress, or a combination of these. It remains unclear whether long-term opioid maintenance treatment (OMT) disrupts reward processing. Here, we measured subjective and objective reward responsiveness in 26 previously heroin-addicted mothers in >7 years stable OMT with minimal psychosocial stress and illicit drug use. The comparison group was 30 healthy age-matched mothers (COMP). Objective reward responsiveness was assessed in a two-alternative forced-choice task with skewed rewards. Results were also compared to performance from an additional 968 healthy volunteers (meta-analytic approach). We further compared subprocesses of reward-based decisions across groups using computational modelling with a Bayesian drift diffusion model of decision making. Self-reported responsiveness to non-drug rewards was high for both groups (means: OMT = 6.59, COMP = 6.67, p = 0.84, BF10 = 0.29), yielding moderate evidence against subjective anhedonia in this OMT group. Importantly, the mothers in OMT also displayed robust reward responsiveness in the behavioral task (t19 = 2.72, p = 0.013, BF10 = 3.98; d = 0.61). Monetary reward changed their task behavior to the same extent as the local comparison group (reward bias OMT = 0.12, COMP = 0.12, p = 0.96, BF10 = 0.18) and in line with data from 968 healthy controls previously tested. Computational modelling revealed that long-term OMT did not even change decision subprocesses underpinning reward behavior. We conclude that reduced sensitivity to rewards and anhedonia are not necessary consequences of prolonged opioid use.

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