Treating Tobacco Use Disorder in Pregnant Women in Medication-Assisted Treatment for an Opioid Use Disorder: A Systematic Review

Akerman, Sarah C.; Brunette, Mary F.; Green, Alan I.; Goodman, Daisy; Blunt, Heather; Heil, Sarah H.

doi:10.1016/j.jsat.2014.12.002

Cited by 47 publications

(49 citation statements)

References 91 publications

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“…A recent review of the literature identified only three interventions testing smoking cessation interventions among pregnant patients enrolled in MAT. 14 Contingency management (an incentive driven program) had an impact on smoking cessation. 25 More research is needed to develop and test tailored tobacco treatment interventions for pregnant, opioid dependent women for implementation in clinics providing MAT.…”

Section: Discussionmentioning

confidence: 99%

“…12 Pregnant patients seeking MAT have high rates of smoking, ranging from 88% to 95%. 13,14 A significant risk of MAT is the development of neonatal abstinence syndrome, a treatable condition characterized by central and autonomic nervous system hyperactivity. 11 Babies who develop neonatal abstinence syndrome may require longer hospital stays 15 or neonatal intensive care unit (NICU) admissions.…”

Section: Smoking Among Pregnant Women In Outpatient Treatment For Opimentioning

confidence: 99%

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Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry

Fallin

Miller

Ashford

2016

NICTOB

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Introduction: Smoking during pregnancy is a major public health issue, contributing to adverse health outcomes. The vast majority of women with substance use disorders smoke during the perinatal period. Medication Assisted Treatment (MAT) is the standard of care for women using opioids during pregnancy. The majority of women engaged in MAT (88%-95%) report smoking. The purposes of this study were to describe: (1) facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT; and (2) strategies to tailor tobacco treatment interventions with this population. Methods: Two semi-structured focus groups lasting approximately 45 minutes each were conducted with 22 women engaged in MAT. Focus groups were recorded, transcribed and analyzed in MAXQDA using content analysis. Results: Participants reported: (1) desire to quit smoking for themselves and their children; (2) aversion to smoking; (3) a turning point in their lives from being pregnant and entering MAT; (4) nicotine dependence; (5) smoking as a way to cope with stress; (6) coping with dual dependencies; (7) past experiences with stopping smoking due to smoking restrictions; (8) perceived lack of success with nicotine replacement therapy or other tobacco treatment medications; and (9) the need for intensive environmental support for quit attempts. Conclusions: Participants were motivated to quit smoking, but faced multiple complex barriers. Integrating tobacco treatment into the psychosocial services offered in conjunction with MAT would allow a healthcare provider to offer tailored tobacco treatment in a supportive environment. Implications: Results of this qualitative study include facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT, as well as strategies to tailor tobacco treatment interventions for this population. In-depth knowledge of the complex barriers facing this patient population can be used to inform tailored tobacco treatment services that can be integrated into clinics providing MAT.

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Section: Discussionmentioning

confidence: 99%

Section: Smoking Among Pregnant Women In Outpatient Treatment For Opimentioning

confidence: 99%

Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry

Fallin

Miller

Ashford

2016

NICTOB

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“…First, participants were pregnant women receiving methadone-assisted treatment for opioid use disorder, a population with a high rate of smoking and for whom many interventions are ineffective (Akerman et al, 2015). Second, participants provided breath and urine samples three times per week throughout the study.…”

Section: Resultsmentioning

confidence: 99%

Contingency management interventions for tobacco and other substance use disorders in pregnancy.

Hand¹,

Ellis²,

Carr³

et al. 2017

Psychology of Addictive Behaviors

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Contingency management (CM) is an effective intervention for reducing use of licit and illicit substances in a variety of populations. Pregnant women are a vulnerable population with much to gain from effective interventions for substance use disorders, and for whom CM interventions may be especially well-suited. We reviewed the literature on CM interventions among pregnant women with tobacco and other substance use disorders with three aims: 1) describe the effectiveness of CM for reducing use of tobacco and other substances during pregnancy, 2) describe the effects of CM interventions on infant outcomes, and 3) identify needs for future research on CM in pregnancy. Our search strategy revealed 27 primary studies of CM in pregnancy. CM was effective in the majority of studies targeting nicotine abstinence, and results were mixed in studies targeting illicit substances. A variety of methodologies were used within the relatively small number of studies making it difficult to identify underlying mechanisms. Also, very few studies reported maternal and infant outcomes, and significant effects of CM were only apparent when secondary analyses pooled data from multiple studies. Furthermore, there is extremely limited data on the cost-effectiveness of CM interventions in pregnancy. Future research should address these three areas to better determine the ultimate value of CM as an efficacious treatment for pregnant women with substance use disorders.

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“…While typically used as an adjunct to treatment, contingency management has been shown to improve access and retention in treatment with pregnant women with substance use disorders in a limited number of studies (Akerman et al, 2015; Jones, Haug, Silverman, Stitzer, & Svikis, 2001). …”

Section: Literature Review and Discussionmentioning

confidence: 99%

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

Goodman

Milliken

Theiler

et al. 2015

Journal of Dual Diagnosis

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Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for cooccurring posttraumatic stress disorder in pregnant women who use substances, in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.

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Treating Tobacco Use Disorder in Pregnant Women in Medication-Assisted Treatment for an Opioid Use Disorder: A Systematic Review

Cited by 47 publications

References 91 publications

Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry

Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry

Contingency management interventions for tobacco and other substance use disorders in pregnancy.

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

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