Prenatal Use of Medication for Opioid Use Disorder and Other Prescription Opioids in Cases of Neonatal Opioid Withdrawal Syndrome: North Carolina Medicaid, 2016–2018

2021 ◽  
pp. e1-e4
Author(s):  
Anna E. Austin ◽  
Vito Di Bona ◽  
Mary E. Cox ◽  
Scott Proescholdbell ◽  
Michael Dolan Fliss ◽  
...  
Keyword(s):  
North Carolina ◽  
Withdrawal Syndrome ◽  
White Women ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Opioid Withdrawal Syndrome ◽  
In Pregnancy

Objectives. To estimate use of medication for opioid use disorder (MOUD) and prescription opioids in pregnancy among mothers of infants with neonatal opioid withdrawal syndrome (NOWS). Methods. We used linked 2016–2018 North Carolina birth certificate and newborn and maternal Medicaid claims data to identify infants with an NOWS diagnosis and maternal claims for MOUD and prescription opioids in pregnancy (n = 3395). Results. Among mothers of infants with NOWS, 38.6% had a claim for MOUD only, 14.3% had a claim for prescription opioids only, 8.1% had a claim for both MOUD and prescription opioids, and 39.1% did not have a claim for MOUD or prescription opioids in pregnancy. Non-Hispanic Black women were less likely to have a claim for MOUD than non-Hispanic White women. The percentage of infants born full term and normal birth weight was highest among women with MOUD or both MOUD and prescription opioid claims. Conclusions. In the 2016–2018 NC Medicaid population, 60% of mothers of infants with NOWS had MOUD or prescription opioid claims in pregnancy, underscoring the extent to which cases of NOWS may be a result of medically appropriate opioid use in pregnancy. (Am J Public Health. Published online ahead of print August 12, 2021: e1–e4. https://doi.org/10.2105/AJPH.2021.306374 )

scholarly journals Buprenorphine for Medication-Assisted Treatment of Opioid Use Disorder in Pregnancy: Relationship to Neonatal Opioid Withdrawal Syndrome

2017 ◽  
Vol 07 (04) ◽  
pp. e215-e222 ◽  
Author(s):  
Niraj Chavan ◽  
Kristin Ashford ◽  
Amanda Wiggins ◽  
Michelle Lofwall ◽  
Agatha Critchfield
Keyword(s):  
Withdrawal Syndrome ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Study Cohort ◽  
Urine Drug Screen ◽  
Opioid Use ◽  
Medication Assisted Treatment ◽  
Positive Urine ◽  
Opioid Withdrawal Syndrome ◽  
In Pregnancy

Objective To examine the relationship between antepartum buprenorphine dose for medication-assisted treatment (MAT) of opioid use disorder (OUD) and incident neonatal opioid withdrawal syndrome (NOWS). Study Design We performed a prospective cohort study of pregnant women with a singleton gestation diagnosed with OUD and receiving buprenorphine for MAT at a tertiary care academic institution from July 2015 to January 2017. We divided the study cohort into two groups—pregnancies with versus without NOWS. Substance abuse patterns in pregnancy, maternal, and neonatal clinical outcomes were compared. Results The incidence of NOWS was 31.11% (n = 28/90) in our study cohort. Pregnancies with NOWS had a significantly higher rate of benzodiazepine positive urine tests and number of positive urine drug screen (UDS) results for illicit opioids. The group without NOWS had significantly higher number of patients with an appropriate UDS result at delivery through postpartum. Rates of neonatal intensive care unit (NICU) admission, length of NICU stay, and maximum Finnegan score were significantly higher in the group with NOWS. Neither the initial (10.6 ± 5.2 versus 10.3 ± 4.8 mg, p = 0.80) nor the final buprenorphine doses (13.3 ± 5.1 versus 13.0 ± 4.6 mg, p = 0.81) were significantly different between study groups. Conclusion The occurrence of NOWS was not related to buprenorphine dose used for MAT.

Maternal opioid use disorder: Placental transcriptome analysis for neonatal opioid withdrawal syndrome

Genomics ◽  
2021 ◽  
Author(s):  
Uppala Radhakrishna ◽  
Swapan K. Nath ◽  
Sangeetha Vishweswaraiah ◽  
Lavanya V. Uppala ◽  
Ariadna Forray ◽  
...  
Keyword(s):  
Transcriptome Analysis ◽  
Withdrawal Syndrome ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Opioid Use ◽  
Opioid Withdrawal Syndrome

Maternal and neonatal characteristics of a Canadian urban cohort receiving treatment for opioid use disorder during pregnancy

2018 ◽  
Vol 10 (1) ◽  
pp. 132-137 ◽  
Author(s):  
C. Miller ◽  
D. Grynspan ◽  
L. Gaudet ◽  
E. Ferretti ◽  
S. Lawrence ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Retrospective Chart Review ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Opioid Use ◽  
Maternal Characteristics ◽  
Ottawa Hospital ◽  
Increased Risk ◽  
Opioid Replacement Therapy ◽  
In Pregnancy

AbstractThe epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.

scholarly journals Targeting the Orexin System for Prescription Opioid Use Disorder

2020 ◽  
Vol 10 (4) ◽  
pp. 226 ◽  
Author(s):  
Alessandra Matzeu ◽  
Rémi Martin-Fardon
Keyword(s):  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Effective Strategies ◽  
System A ◽  
Clinical Pain ◽  
Promising Target ◽  
Nonmedical Use ◽  
Prescription Opioid Use

Prescription opioids are potent analgesics that are used for clinical pain management. However, the nonmedical use of these medications has emerged as a major concern because of dramatic increases in abuse and overdose. Therefore, effective strategies to prevent prescription opioid use disorder are urgently needed. The orexin system has been implicated in the regulation of motivation, arousal, and stress, making this system a promising target for the treatment of substance use disorder. This review discusses recent preclinical studies that suggest that orexin receptor blockade could be beneficial for the treatment of prescription opioid use disorder.

Naldemedine-induced opioid withdrawal syndrome with severe psychiatric symptoms in an advanced cervical cancer patient without brain metastasis

2021 ◽  
pp. 1-3
Author(s):  
Mayumi Ishida ◽  
Mie Hiraoka ◽  
Ayako Yaguchi ◽  
Koji Sugano ◽  
Nasako Adachi ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Brain Metastasis ◽  
Withdrawal Syndrome ◽  
Psychiatric Symptoms ◽  
Opioid Withdrawal ◽  
Cervical Cancer Patient ◽  
Opiate Withdrawal ◽  
Opioid Use ◽  
Behavioral Abnormalities ◽  
Opioid Withdrawal Syndrome

Abstract Objective Naldemedine, an oral peripheral μ-opioid receptor antagonist, was developed for the treatment of constipation, a side effect of opioid use. Naldemedine is not generally recognized as causing opioid withdrawal in which associated symptoms affecting the central nervous system. Method From the series of cancer patients undergoing symptom management, we report a case treated with naldemedine for constipation in relation to the use of opioids for cancer pain and who displayed severe psychological symptoms associated with withdrawal immediately after the use of naldemedine. Results The patient was a 36-year-old woman diagnosed with cervical cancer Stage IIB, PS3. When the patient, who was using oxycodone hydrochloride hydrate (80 mg/day) for ileal pain, was started on naldemedine for constipation, she complained of sweating after just 5 min and hallucinations after 1 h. The patient also displayed physical/behavioral abnormalities such as diarrhea and hyperactivity, and psychological abnormalities such as aggression toward staff. Despite the psychiatric symptoms worsening over time, there were no abnormalities in terms of blood biochemical data, and no brain metastasis was observed on MRI. Based on the Clinical Opiate Withdrawal Scale, these symptoms were judged to indicate opioid withdrawal. Naldemedine was discontinued due to naldemedine-related opioid withdrawal syndrome and, thereafter, the psychiatric symptoms diminished, with no recurrence of similar symptoms observed to date. Significance of results If mental and behavioral abnormalities occur in patients receiving naldemedine, it is necessary to consider the possibility of opioid withdrawal syndrome as a differential diagnosis.

scholarly journals Dynamic Changes in Prescription Opioids from 2006 to 2017 in Texas

2019 ◽  
Author(s):  
Ebuwa T Ighodaro ◽  
Kenneth L McCall ◽  
Daniel Y Chung ◽  
Stephanie D Nichols ◽  
Brian J Piper
Keyword(s):  
Rural Areas ◽  
Opioid Analgesics ◽  
Opioid Use Disorder ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Study Objective ◽  
The Us ◽  
Urban And Rural Areas ◽  
Opioid Diversion

AbstractStudy ObjectiveThe US is experiencing an epidemic of opioid overdoses which may be at least partially due to an over-reliance on opioid analgesics in the treatment of chronic non-cancer pain and subsequent escalation to heroin or illicit fentanyl. As Texas was reported to be among the lowest in the US for opioid use and misuse, further examination of this state is warranted.Study DesignThis study was conducted to quantify prescription opioid use in Texas.Data SourceData was obtained from the publically available US Drug Enforcement Administration’s Automation of Reports and Consolidated Orders System (ARCOS) which monitors controlled substances transactions from manufacture to commercial distribution.Measurement and Main ResultsData for 2006-2017 from Texas for ten prescription opioids including eight primarily used to relieve pain (codeine, fentanyl, hydrocodone, hydromorphone, meperidine, morphine, oxycodone, oxymorphone) and two (buprenorphine and methadone) for the treatment of an Opioid Use Disorder (OUD) were examined. The change in Morphine Mg Equivalent (MME) of all opioids (+23.3%) was only slightly greater than the state’s population gains (21.1%). Opioids used to treat an OUD showed pronounced gains (+90.8%) which were four-fold faster than population growth. Analysis of individual agents revealed pronounced elevations in codeine (+387.5%), hydromorphone (+106.7%), and oxycodone (+43.6%) and a reduction in meperidine (−80.3%) in 2017 relative to 2006. Methadone in 2017 accounted for a greater portion (39.5%) of the total MME than hydrocodone, oxycodone, morphine, hydromorphone, oxymorphone, and meperidine, combined. There were differences between urban and rural areas in the changes in hydrocodone and buprenorphine.ConclusionsCollectively, these findings indicate that continued vigilance is needed in Texas to appropriately treat pain and an OUD while minimizing the potential for prescription opioid diversion and misuse. Texas may lead the US in a return to pre opioid crisis prescription levels.

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