Opioid Dependence During Pregnancy妊娠期阿片类药物依赖.pptVIP

NAS Time course depends on: Opioid half-life (T ?) Fetal opioid storage metabolism Risk factors: Opioid dependent mom ? 70% chance NAS Smoking ? severity Prematurity ? severity * ? AMSP 2009 * ? AMSP 2009 This Lecture Reviews Definitions ? Causes, course, prevalence comorbidities ? Medical complications ? Treatment * ? AMSP 2009 4 Treatments Reviewed Psychosocial rx without medication Methadone maintenance (MM) Methadone-assisted withdrawal Buprenorphine (Subutex?) maintenance * ? AMSP 2009 Psychosocial Interventions Cornerstone Therapeutic alliance Expect demanding resistant behavior Complete assessment Assist with all problems * ? AMSP 2009 Methadone Maintenance Long T ? (27 hrs), synthetic opioid agonist Strict federal regulations Opioid dependent 1 yr (unless preg) 18 yrs unless parental consent/failed rx Daily visits x 90 days * ? AMSP 2009 Many Treatment Goals Mother: ?/stop withdrawal ?/stop drug use Prenatal/med/psych rx Psychosocial probs Supportive network Parenting skills * ? AMSP 2009 Many Treatment Goals Fetus/neonate Stable intrauterine environment Stop intox/withdrawal cycles Deliver term/healthy newborn + maternal/fetal bond * ? AMSP 2009 Components of MM Treatment Multidisciplinary team Individual group counseling Parenting classes Daily oral methadone dosing Start at 30 mg (40 mg max day 1) 50 mg maintenance dose Blocks + illicit opioid effects Prevents withdrawal * ? AMSP 2009 MM Benefits 3x ? in mom’s opiate use ? Prenatal care 3x ? LBW ? Perinatal HIV transmission to 2% 2x ? maternal custody of newborn * ? AMSP 2009 MM Limitations Availability Limited patient acceptance Does not ? incidence of NAS Report of fine motor skill problems * ? AMSP 2009 Methadone-assisted Withdrawal 1970’s = standard rx until fetal deaths Utilized if MM not available or accepted Goals: ? Mother/fetus opioid withdrawal Achieve opioid free state in mom/fetus Deliver term, healthy fetus with no NAS * ? AMSP 2009 Components of With