Detoxification from opiate drugs during pregnancy

Bell, Jennifer J.; Towers, Craig V.; Hennessy, Mark; Heitzman, Callie; Smith, Barbara K.; Chattin, Katie

doi:10.1016/j.ajog.2016.03.015

Cited by 72 publications

(85 citation statements)

References 11 publications

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“…25 In Bell et al, women who were involuntarily detoxified while incarcerated received clonidine and supportive medications. 19 The reported duration of withdrawal ranged from 3 days to 16 weeks and was not reported in five studies. Only seven studies reported fetal monitoring, and only one described fetal monitoring as part of a formal detoxification protocol.…”

Section: Resultsmentioning

confidence: 97%

“…All included studies were observational and only five studies had prospectively collected data. 19–23 Before detoxification, most participants had documented opioid use (primarily through urine drug testing), although the distinction between heroin and prescription opioids was not always clear. Other non-opioid illicit substance use was reported in six studies 20,23–27 and tobacco use was reported in five.…”

Section: Resultsmentioning

confidence: 99%

“…22,25 Three studies included patients who were incarcerated at the time of the detoxification. 19,25,32 In Bell et al, 108 women with opioid use disorder underwent “involuntary withdrawal” as a result of the absence of opioid pharmacotherapy availability in the penal system. 19 In Haabrekke et al, eight women were involuntarily institutionalized and forced into detoxification 25 ; in Sinha et al, of the 10 women who completed detoxification, nine did so without medical supervision (“quit cold turkey”) and one underwent supervised withdrawal in prison.…”

Section: Resultsmentioning

confidence: 99%

“…19,25,32 In Bell et al, 108 women with opioid use disorder underwent “involuntary withdrawal” as a result of the absence of opioid pharmacotherapy availability in the penal system. 19 In Haabrekke et al, eight women were involuntarily institutionalized and forced into detoxification 25 ; in Sinha et al, of the 10 women who completed detoxification, nine did so without medical supervision (“quit cold turkey”) and one underwent supervised withdrawal in prison. 32 Gestational age at the time of withdrawal was reported in all but the oldest study 30 and predominantly occurred in the second or third trimester.…”

Section: Resultsmentioning

confidence: 99%

“…Except for Sinha et al, 32 which used a scoring system described by Rivers (Rivers score greater than 2), 35 all of the studies used the Finnegan scoring system to determine treatment for neonatal abstinence syndrome. 36 A Finnegan score greater than 7 was used by one study, 20 a score 8 or greater was used by four studies, 21,24,25,31 a score 9 or greater was used by two studies, 26,28 a score 10 or greater was used by one study, 19 and the scores used to treat neonates were not recorded in two studies. 27,30 In addition to variability in scoring thresholds, many studies required more than two threshold scores to initiate treatment.…”

Section: Resultsmentioning

confidence: 99%

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Opioid Detoxification During Pregnancy

Terplan

Laird

Hand

et al. 2018

Obstetrics &Amp; Gynecology

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OBJECTIVE To systematically review maternal and neonatal outcomes associated with opioid detoxification during pregnancy. DATA SOURCES PubMed, PsycINFO, EMBASE, Cochrane, and ClinicalTrials.gov databases were searched from January 1, 1966, to September 1, 2016. METHODS OF STUDY SELECTION English-language studies that reported outcomes associated with opioid detoxification among pregnant women with opioid use disorder were included. Nonoriginal research articles (case reports, editorials, reviews) and studies that failed to report outcomes for detoxification participants were excluded. Bias was assessed using the Cochrane Collaboration’s tool for assessing risk of bias and quality was assessed using the U.S. Preventive Service Task Force Quality of Evidence scale. TABULATION, INTEGRATION, AND RESULTS Of 1,315 unique abstracts identified, 15 met criteria for inclusion and included 1,997 participants, of whom 1,126 underwent detoxification. Study quality ranged from fair to poor as a result of the lack of a randomized control or comparison arm and high risk of bias across all studies. Only nine studies had a comparison arm. Detoxification completion (9–100%) and illicit drug relapse (0–100%) rates varied widely across studies depending on whether data from participants who did not complete detoxification or who were lost to follow-up were included in analyses. The reported rate of fetal loss was similar among women who did (14 [1.2%]) and did not undergo detoxification (17 [2.0%]). CONCLUSIONS Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Opioid Detoxification During Pregnancy

Terplan

Laird

Hand

et al. 2018

Obstetrics &Amp; Gynecology

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Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone

Straub,

Bateman,

Hernández-Díaz

et al. 2024

JAMA

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ImportanceBuprenorphine combined with naloxone is commonly used to treat opioid use disorders outside of pregnancy. In pregnancy, buprenorphine alone is generally recommended because of limited perinatal safety data on the combination product.ObjectiveTo compare perinatal outcomes following prenatal exposure to buprenorphine with naloxone vs buprenorphine alone.Design, Settings, and ParticipantsPopulation-based cohort study using health care utilization data from Medicaid-insured beneficiaries in the US from 2000 to 2018. The cohort was restricted to pregnant individuals linked to their liveborn infants, with maternal Medicaid enrollment from 3 months before pregnancy to 1 month after delivery and infant enrollment for the first 3 months after birth, unless they died sooner.ExposureUse of buprenorphine with naloxone vs buprenorphine alone during the first trimester based on outpatient dispensings.Main Outcomes and MeasuresOutcomes included major congenital malformations, low birth weight, neonatal abstinence syndrome, neonatal intensive care unit admission, preterm birth, respiratory symptoms, small for gestational age, cesarean delivery, and maternal morbidity. Confounder-adjusted risk ratios were calculated using propensity score overlap weights.ResultsThis study identified 3369 pregnant individuals exposed to buprenorphine with naloxone during the first trimester (mean [SD] age, 28.8 [4.6] years) and 5326 exposed to buprenorphine alone or who switched from the combination to buprenorphine alone by the end of the first trimester (mean [SD] age, 28.3 [4.5] years). When comparing buprenorphine combined with naloxone with buprenorphine alone, a lower risk for neonatal abstinence syndrome (absolute risk, 37.4% vs 55.8%; weighted relative risk, 0.77 [95% CI, 0.70-0.84]) and a modestly lower risk for neonatal intensive care unit admission (absolute risk, 30.6% vs 34.9%; weighted relative risk, 0.91 [95% CI, 0.85-0.98]) and small for gestational age (absolute risk, 10.0% vs 12.4%; weighted relative risk, 0.86 [95% CI, 0.75-0.98]) was observed. For maternal morbidity, the comparative rates were 2.6% vs 2.9%, respectively, and the weighted relative risk was 0.90 (95% CI, 0.68-1.19). No differences were observed with respect to major congenital malformations overall, low birth weight, preterm birth, respiratory symptoms, or cesarean delivery. Results were consistent across sensitivity analyses.Conclusions and RelevanceThere were similar and, in some instances, more favorable neonatal and maternal outcomes for pregnancies exposed to buprenorphine combined with naloxone compared with buprenorphine alone. For the outcomes assessed, compared with buprenorphine alone, buprenorphine with naloxone during pregnancy appears to be a safe treatment option. This supports the view that both formulations are reasonable options for the treatment of opioid use disorder in pregnancy, affirming flexibility in collaborative treatment decision-making.

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Physiologically based pharmacokinetic modeling of long‐acting extended‐release naltrexone in pregnant women with opioid use disorder

Shenkoya,

Gopalakrishnan,

Eke

2024

CPT Pharmacom & Syst Pharma

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Opioid use disorders (OUD) are a major issue in the U.S. Current treatments for pregnant women, like methadone and buprenorphine require daily dosing and have adverse effects. Monthly injectable naltrexone (XR‐NTX) mitigates these adverse effects but is not recommended during pregnancy due to limited pharmacokinetic and safety data. This study developed a physiologically based pharmacokinetic (PBPK) model to describe XR‐NTX pharmacokinetics during pregnancy, and to predict dosing recommendations. Model predictions were successfully validated with observed data. Maternal plasma XR‐NTX profiles were simulated for 400 non‐pregnant virtual females at the approved dose of 380 mg, then randomized to continue with either 380, 285, 190, or 95 mg during pregnancy. The non‐pregnant virtual females had a mean predicted Cmax, AUC0‐7days, and AUC0‐28days of 23.3 ng/mL, 142 ng·d/mL, and 148 ng·d/mL, respectively. Maternal XR‐NTX exposure (AUC0‐28days) were predicted to increase by 1.37, 1.43, and 1.72 times during the first, second, and third trimester of pregnancy. However, the fetal‐to‐maternal exposure (AUC0‐28days) was lower in the first (15%), second (7%), and third (9%) trimesters. A dose of 285 mg of XR‐NTX in pregnancy during the first/second trimester and dose of 190 mg in the third trimester were predicted to provide maternal exposures that were comparable to non‐pregnant levels at the standard dose. This study provides crucial insights into XR‐NTX pharmacokinetics and proposes a dosing strategy during pregnancy, potentially aiding further clinical investigations and decision making regarding XR‐NTX use during pregnancy.

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Detoxification from opiate drugs during pregnancy

Cited by 72 publications

References 11 publications

Opioid Detoxification During Pregnancy

Opioid Detoxification During Pregnancy

Comparative Safety of In Utero Exposure to Buprenorphine Combined With Naloxone vs Buprenorphine Alone

Physiologically based pharmacokinetic modeling of long‐acting extended‐release naltrexone in pregnant women with opioid use disorder

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