Browsing by Subject "neonatal abstinence syndrome"

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    Policy perceptions of US state public health and child and family services regarding maternal opioid use and neonatal exposure
    (Elsevier, 2019) Scott, Lisa Fath; Stone, Cynthia; Duwve, Joan; Health Policy and Management, School of Public Health
    Objective To explore how state legislatures and departments of health are responding to the public health and economic issues of increases in opioid use disorder and the impact on pregnant women and infants. Design The design was a non-experimental descriptive study using a mixed methods survey research approach. Setting Electronic and telephone survey of individuals from state departments of health associated with departments of behavioral health and substance use, or child and family services. Participants Fifty-two respondents employed by individual state departments of health and child and family services. Methods Univariate analysis and frequency distribution of ordinal variables was completed. Thematic analysis was used to analyze free text questions and identify themes. Results All states reported recent changes or plans to address the problem of opioid misuse in their state. Many respondents feel their state continues to lack adequate services for treatment. Some states are exploring unique methods for addressing this in a safe and timely fashion, such as moving medication-assisted treatment to primary care and expanding licensure to Primary Care Physicians (PCPs) and nurse practitioners. Conclusions Our findings demonstrate an increased commitment throughout the United States to enhance access to clinically appropriate treatment of substance use disorder particularly during pregnancy, consider unique methods for addressing the problem of opioid dependency, and increase education and primary prevention programs.
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    Stereoselective Analysis of Methadone and EDDP in Laboring Women and Neonates in Plasma and Dried Blood Spots and Association with Neonatal Abstinence Syndrome
    (Thieme, 2021) Metzger, Ingrid F.; Thomas, Anna E.; Evrard, Cindy A.; Jones, David R.; Masters, Andrea R.; Haas, David M.; Haneline, Laura S.; Quinney, Sara K.; Obstetrics and Gynecology, School of Medicine
    Objective This pilot study evaluated the relationship between maternal and neonatal R- and S-methadone and R- and S-2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) exposure and the severity of neonatal abstinence syndrome (NAS). The use of dried blood spots (DBS) as an alternative for plasma in assessing methadone and EDDP was also assessed. Study Design Women receiving methadone for medication assisted treatment of opioid use disorder during pregnancy were eligible for recruitment. Plasma and DBS samples were collected from mothers during labor, from cord blood, and from newborns during genetic screen. R-/S-methadone and EDDP were measured by high-performance liquid chromatography tandem mass spectrometry (HPLC/MS/MS). Associations between methadone exposure, neonatal morphine requirements, and severity of NAS were examined. Results Twenty women and infants completed the study. Maternal methadone dose at delivery was 112 mg/day (range = 60–180 mg/day). Sixteen neonates experienced NAS requiring morphine; three also required phenobarbital. Higher cord blood concentrations of R-methadone, R- and S-EDDP were associated with higher maximum doses of morphine (p < 0.05). Conclusion Maternal methadone and cord blood concentration at delivery are variable and may be potential markers of neonatal abstinence syndrome.