Treating Tobacco Use Disorder in Pregnant Women in Medication-Assisted Treatment for an Opioid Use Disorder: A Systematic Review
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Opiate Substitution Treatment
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Methadone maintenance
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( N Engl J Med . 2022;387:2033–2044) Opioid use during pregnancy has been on the rise since 2000. The standard care for opioid use disorder during pregnancy is either buprenorphine or methadone treatment, which both have been shown to improve maternal and neonatal outcomes. Buprenorphine may have greater benefits, yet data is limited. This study aimed to analyze the risk of adverse outcomes for mother and baby with buprenorphine treatment compared to methadone treatment for opioid use during pregnancy.
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New clinical studies indicate that buprenorphine can be a promising alternative to methadone for treating opioid use disorder (OUD) in pregnant women. Various benefits for the mother have been identified with buprenorphine's unique pharmacokinetics, effect on clinical outcomes, and convenience for the patient. With the growing problem of OUD in pregnant women, clinicians must be aware of treatment options and their associated advantages and disadvantages.
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Abstract Background Hospitals are an essential site of care for people with opioid use disorder (OUD). Buprenorphine and methadone are underutilized in the hospital. Objectives Characterize barriers to in‐hospital buprenorphine or methadone initiation to inform implementation strategies to increase OUD treatment provision. Design, Settings, and Participants Survey of hospital‐based clinicians' perceptions of OUD treatment from 12 hospitals conducted between June 2022 and August 2022. Measures Survey questions were grouped into six domains: (1) evidence to treat OUD, (2) hospital processes to treat OUD, (3) buprenorphine or methadone initiation, (4) clinical practices to treat OUD, (5) leadership prioritization of OUD treatment, and (6) job satisfaction. Likert responses were dichotomized and associations between “readiness” to initiate buprenorphine or methadone and each domain were assessed. Results Of 160 respondents (60% response rate), 72 (45%) reported higher readiness to initiate buprenorphine compared to methadone, 55 (34%). Respondents with higher readiness to initiate medications for OUD were more likely to perceive that evidence supports the use of buprenorphine and methadone to treat OUD ( p < .001), to perceive fewer barriers to treat OUD ( p < .001), to incorporate OUD treatment into their clinical practice ( p < .001), to perceive leadership support for OUD treatment ( p < .007), and to have great job satisfaction ( p < .04). Clinicians reported that OUD treatment protocols with treatment linkage, increased education, and addiction specialist support would facilitate OUD treatment provision. Conclusion Interventions that incorporate protocols to initiate medications for OUD, include addiction specialist support and education, and ensure postdischarge OUD treatment linkage could facilitate hospital‐based OUD treatment provision.
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Opioid use disorder (OUD) and schizophrenia are commonly comorbid, and patient outcomes are improved when these conditions are managed concurrently. Medication for OUD such as methadone and buprenorphine are treatments for OUD, yet psychosis introduces additional challenges in retaining patients in care. Extended-release depot buprenorphine is an emerging option for the treatment of moderate-to-severe OUD, and it may provide certain benefits in patients with concurrent OUD and psychosis. We present the case of a 32-year-old man with schizophrenia, traumatic brain injury, and OUD with a history of multiple opioid-related overdoses, followed by an assertive community treatment team, and subject to a community treatment order for both his primary psychotic disorder and OUD treatments. We discuss the role of extended-release depot buprenorphine in this unique patient population and the ethical considerations of involuntary treatment of OUD in patients lacking capacity to consent to treatment.
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Like buprenorphine, methadone is a life-saving medication that can be initiated in the emergency department (ED) to treat patients with an opioid use disorder (OUD). The purpose of this study was to better understand the attitudes of emergency physicians (EP) on offering methadone compared to buprenorphine to patients with OUD in the ED.We distributed a perception survey to emergency physicians through a national professional network.In this study, the response rate was 18.4% (N = 141), with nearly 70% of the EPs having ordered either buprenorphine or methadone. 75% of EPs strongly or somewhat agreed that buprenorphine was an appropriate treatment for opioid withdrawal and craving, while only 28% agreed that methadone was an appropriate treatment. The perceived barriers to using buprenorphine and methadone in the ED were similar.It is essential to create interventions for EPs to overcome stigma and barriers to methadone initiation in the ED for patients with opioid use disorder. Doing so will offer additional opportunities and pathways for initiation of multiple effective medications for OUD in the ED. Subsequent outpatient treatment linkage may lead to improved treatment retention and decreased morbidity and mortality from ongoing use.
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Buprenorphine has been used internationally for the treatment of opioid use disorder (OUD) since the 1990s and has been available in the United States for more than a decade. Initial practice recommendations were intentionally conservative, were based on expert opinion, and were influenced by methadone regulations. Since 2003, the American crisis of OUD has dramatically worsened, and much related empirical research has been undertaken. The findings in several important areas conflict with initial clinical practice that is still prevalent. This article reviews research findings in the following 7 areas: location of buprenorphine induction, combining buprenorphine with a benzodiazepine, relapse during buprenorphine treatment, requirements for counseling, uses of drug testing, use of other substances during buprenorphine treatment, and duration of buprenorphine treatment. For each area, evidence for needed updates and modifications in practice is provided. These modifications will facilitate more successful, evidence-based treatment and care for patients with OUD.
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As the opioid crisis continues to worsen in the United States, nurses must take on a central role of intervention, which includes use of the opioid agonist medication, buprenorphine. The current article addresses the need to understand opioid use disorder as a chronic condition and increase access to treatment with pharmacotherapies, particularly buprenorphine, in outpatient settings. The pharmacological activity of buprenorphine is discussed, as well as the reasons for its underutilization, specifically stigma. Nurses can be frontline leaders in the fight against the opioid crisis by addressing stigma and increasing access to the life-saving medication, buprenorphine. [Journal of Psychosocial Nursing and Mental Health Services, 56(11), 9-12.].
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