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Pregnancy & Addiction 2011 - Revision 2

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•
S
Stacy Seikel
Health & Medicine
1 of 50
Pregnancy & Addiction Stacy Seikel, MD Medical Director The Center For Drug-Free Living, Inc.
Learning Objectives ,[object Object],[object Object],[object Object],[object Object]
How Prevalent is drug and alcohol use in pregnancy? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Factor: Family History and Social Situation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clues in the medical history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],+
Screening ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Barriers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Alcohol ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical Complications: of Drug Abuse in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Obstetrical Complications Opiate Abuse ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MMT in Perinatal Addiction – Major Points ,[object Object],[object Object]
Various Discipline See the Maternal Fetal Dyad Differently ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interdisciplinary Program Orange County Jail Winnie Palmer Hospital Maternity and Neonatal Care Opiate Treatment Program (CFDFL) Methadone Dosing Counseling Psychiatric Care PPWI/CFDFL Residential Treatment Detox/ARF CFDFL
Pregnant Patients Receive All the Same Benefits as Non-Pregnant Patients on Maintenance Therapy ,[object Object],[object Object],[object Object]
Opioid Agonist Maintenance in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pregnancy Specific Benefits of Opioid Maintenance Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of Opioid Agonist Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of Pharmacotherapy with Methadone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Principles of Pharmacotherapy with Buprenorphine (Subutex) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Getting the Prenatal Dose Right: Induction and Stabilization
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methadone Induction for the Pregnant Patient ,[object Object],[object Object],[object Object],[object Object],[object Object]
Safe and Effective Induction with Methadone: Outpatient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Buprenorphine in Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Methadone vs. Buprenorphine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ongoing Illicit or Polysubstance Use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Right Dose Throughout Pregnancy (is the dose that stops withdrawal) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Intrapartum and Postpartum Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Breastfeeding on Methadone Alex Grey “ Nursing” 1985 Oil on Linen
Breastfeeding on Methadone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Calculations of the methadone level in a breastfeeding infant. Methadone doses of 25 to 180 mg/d  milk concentrations in milk from 27 to 260 ng/ mL. Based on an estimated milk intake of 500 mL/d in an infant, average daily methadone ingestion is 0.05 mg. In an 11 pound baby, the ingested amount is thus less than 1% of the maternal weight-adjusted dose. Methadone clearance in neonates is slower than adults, but the infant dose will not exceed 5% of the maternal weight-adjusted dose. Glatstein, MM et al (2008) Canadian Family Physician 54(12): 1689-90.
Conclusions ,[object Object],[object Object],[object Object]
METHADONE AND BUPRENORPHINE: PRESENTATION AND MANAGEMENT Neonatal Abstinence Syndrome
Methadone Associated Neonatal Abstinence Syndrome (NAS) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NAS Buprenorphine: What We Know ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
NAS Buprenorphine: What We Don’t Know ,[object Object],[object Object],[object Object],[object Object]
Initial Neonatal Work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Supportive Non-Pharmacologic Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacologic Management of NAS ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management with Oral Morphine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stabilization and Detoxification ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Troubleshooting ,[object Object],[object Object],[object Object],[object Object]
Discharge Planning ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WWW Resources ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WWW Resources ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methadone & Pregnancy Fact Sheet ,[object Object],[object Object],[object Object],[object Object],[object Object]
Methadone & Pregnancy Fact Sheet ,[object Object],[object Object],[object Object]
Methadone & Pregnancy Fact Sheet ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Thank you.

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Pregnancy & Addiction 2011 - Revision 2

  • 1. Pregnancy & Addiction Stacy Seikel, MD Medical Director The Center For Drug-Free Living, Inc.
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  • 13. Interdisciplinary Program Orange County Jail Winnie Palmer Hospital Maternity and Neonatal Care Opiate Treatment Program (CFDFL) Methadone Dosing Counseling Psychiatric Care PPWI/CFDFL Residential Treatment Detox/ARF CFDFL
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  • 20. Getting the Prenatal Dose Right: Induction and Stabilization
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  • 30. Breastfeeding on Methadone Alex Grey “ Nursing” 1985 Oil on Linen
  • 31.
  • 32. Calculations of the methadone level in a breastfeeding infant. Methadone doses of 25 to 180 mg/d  milk concentrations in milk from 27 to 260 ng/ mL. Based on an estimated milk intake of 500 mL/d in an infant, average daily methadone ingestion is 0.05 mg. In an 11 pound baby, the ingested amount is thus less than 1% of the maternal weight-adjusted dose. Methadone clearance in neonates is slower than adults, but the infant dose will not exceed 5% of the maternal weight-adjusted dose. Glatstein, MM et al (2008) Canadian Family Physician 54(12): 1689-90.
  • 33.
  • 34. METHADONE AND BUPRENORPHINE: PRESENTATION AND MANAGEMENT Neonatal Abstinence Syndrome
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