Methadone use in pregnancy: evidence of progression in the severity of addiction.

The number of opiate users is well documented; however, the severity of opiate use has received little attention. This retrospective study in a North of England hospital updates the progression in the severity of addiction in pregnancy. Patients treated were reviewed and the doses of prescribed methadone documented. Historical data were also used for comparison. The severity in addiction in pregnancy was assessed by the woman's drug usage expressed as the daily dose of prescribed methadone at the end of pregnancy. From 2001 to 2008 there was an increase in the mean dose of methadone prescribed at delivery from 28.2 ml/day in 2001 to 57.9 ml/day in 2008. Historically, the use was 27.3 ml/day in 1992-1996 and 32.4 ml/day in 1997-2003. No trend was noted in the number of pregnant users. In conclusion, we observed no recent increase in the number of methadone users presenting, but the severity of drug usage in pregnancy has increased.

The influence of maternal opiate use in pregnancy on second trimester biochemical markers for Down syndrome.

OBJECTIVE: The object of this study is to examine the influence of maternal opiate use on the levels of second trimester biochemical markers for Down syndrome. Maternal opiate use is known to be associated with problems of placental origin and it is possible that the secretion of alpha-feto protein (AFP), free-beta human chorionic gonadotrophin (HCG) and unconjugated oestriol (UE) differs from that of a normal population. METHOD: Seventy nine women who used opiates in pregnancy were compared to a control group of seventy nine women who did not use opiates and their adjusted marker levels analysed. RESULTS: The adjusted median MoM in the opiate and control groups respectively were: AFP (1.00 vs 0.94), HCG (0.95 vs 1.04) and UE (0.96 vs 1.02), with no significant difference between these groups. CONCLUSION: This study suggests that the current practice of calculating the risk of Down syndrome from second trimester biochemistry in women using opiate can be performed using data derived from a normal population.

Pregnancy outcome in women who use opiates.

BACKGROUND: Opiate use in pregnancy is on the increase. There are a number of complications associated with this problem but current data from UK centres are sparse. DESIGN: A retrospective study. SETTING: A North of England Hospital. METHODS: Maternal and neonatal case records were studied and a standard data set completed. MAIN OUTCOME MEASURES: Maternal and neonatal outcomes were classified by the woman's drug usage at the end of pregnancy. RESULTS: One hundred and ten babies born to 108 women were studied and 41% had evidence of previous exposure to the hepatitis C virus. Women who took heroin in later pregnancy were significantly more likely than women who were stabilised on methadone to have a baby who needed morphine (40% versus 19%), had higher mean maximum neonatal abstinence scores (NAS) (5.8 versus 4.7) and stayed in the neonatal unit significantly longer (mean 17.2 days versus 11.8 days). There were two neonatal deaths and the overall rate of prematurity was 29%. CONCLUSIONS: The outcome for pregnancy in women who use opiates is complicated by high rates of prematurity and neonatal death. Women who used heroin in later pregnancy had babies who developed more severe NAS and needed a longer hospital stay than women who used only methadone.

The effect of maternal methadone use on the fetal heart pattern: a computerised CTG analysis.

Using a computerised analysis, the cardiotocograph (CTG) from women who use methadone (n= 25) when compared with women who do not use methadone (n= 25) showed a significant reduction in the fetal heart baseline rate, with a significant reduction in number of accelerations and episodes of high variation. The short-term variation, number of decelerations and episodes of low variation were not different between the two groups. The time taken to meet the standardised criteria was not different, and it is possible that a computer-assisted CTG analysis could be more accurate than a naked eye interpretation.

Telephone counseling as an adjunct to antidepressant treatment in the primary care system. A pilot study.

CONTEXT: Many clinical and logistical barriers exist in the primary care model for treating adult depression. OBJECTIVE: To examine the feasibility and clinical effects of a telephone counseling and medication monitoring program for adults starting treatment for depression in primary care. DESIGN: Pilot study with a contemporaneous control group. SETTING: Group Health Cooperative, an HMO serving more than 450,000 persons in western Washington. PATIENTS: Twenty-eight adult primary care patients starting antidepressant treatment (telephone counseling group) were compared with 94 patients receiving usual care (control group). INTERVENTION: Telephone counseling participants received written educational materials addressing depression, followed by six weekly counseling and support sessions delivered over the telephone by a master's-level therapist. The intervention used the transtheoretical model of behavioral change and cognitive-behavioral strategies to enhance self-monitoring, self-management, and coping skills. DATA SOURCES: Telephone interviews and computerized pharmacy and visit records. OUTCOME MEASURES: Participation rate and retention, Hopkins symptom checklist depression scores, medication adherence and dose thresholds, and visits made for depression treatment. RESULTS: Ninety-three percent of telephone counseling participants contacted agreed to participate, and 92% completed the intervention. Telephone counseling patients showed significantly lower depressive symptoms than did control group patients at 3-month follow-up (0.89 vs. 1.13) and 6-month follow-up (0.79 vs. 0.95; P = 0.03). Telephone counseling patients were twice as likely to adhere to antidepressant medication with adequate dose thresholds (25% vs. 13%) and half as likely to meet criteria for major depression than were control group patients across time (8% vs. 16%), although these differences were not statistically significant. Total outpatient visits made for depression treatment between groups across time did not differ. Overall program cost per patient was estimated at about $150. CONCLUSIONS: A telephone counseling and medication monitoring intervention was well accepted by adult patients starting treatment for depression in primary care. The intervention seems to significantly improve depression outcomes without affecting the number of visits for treatment of depression.