Buprenorphine medication-assisted treatment during pregnancy: An exploratory factor analysis associated with adherence
Buprenorphine medication-assisted treatment during pregnancy: An exploratory factor analysis associated with adherence
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DOI：
10.1016/j.drugalcdep.2018.07.042
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发表时间：
2018-11-01
影响因子：
4.2
通讯作者：
Stowe, Zachary N.
中科院分区：
文献类型：
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作者：
Coker, Jessica L.;Catlin, David;Stowe, Zachary N.
背景：阿片类药物使用障碍孕妇的治疗是具有挑战性的，因为有无数的生理、心理和社会并发症。影响孕期丁丙诺啡依从性的因素尚未确定。材料和方法：在三级诊所接受阿片类药物使用障碍的孕妇纳入了从丁丙诺啡引产到分娩的回顾图表。纳入了2014年1月1日至2016年9月31日期间接受丁丙诺啡评估和治疗的所有女性。坚持的定义如下：1)坚持：参加过随访、尿毒学阴性筛查和阶段推进；2)中度坚持：参加过随访，直到分娩，没有完成六次尿毒学阴性筛查，或尿毒学筛查呈阳性(即没有阶段推进)；3)未坚持：错过了随访，直到分娩才继续接受治疗。结果：女性符合纳入标准的有41名(%)，8名(13%)中等依从者，15名(23%)未依从者。未依从组的临床阿片戒断评分显著高于粘附组，而丁丙诺啡日剂量明显低于未依从组。结论：孕期未依从者的阿片戒断症状严重程度较高，丁丙诺啡的剂量较低。应进一步探讨这些发现，以期在不增加新生儿风险的情况下优化护理。
Background: : The treatment of pregnant women with opioid use disorder is challenging due to the myriad of physical, mental, and social complications. Factors influencing adherence to buprenorphine during pregnancy have not been identified.Materials and methods: : Pregnant women with opioid use disorder followed in a tertiary clinic were included in a retrospective chart review from buprenorphine induction through delivery. All women who had been evaluated and treated with buprenorphine from January 1, 2014, to September 31, 2016, were included. Adherence was defined as follows: 1) adherent: attended follow up visits, negative urine toxicology screens, and phase advancement; 2) moderately adherent: attended follow up visits until delivery, had not completed six negative urine toxicology screens, or had positive urine toxicology screens (i.e., no phase advancement); 3) non-adherent: missed follow up visits and did not stay in treatment until delivery. Sociodemographic characteristics, family psychiatric history, current and lifetime psychiatric and childhood trauma along with treatment factors were compared by category of adherence.Results: : 64 women met criteria for inclusion in this study with 41 (64%) adherent; eight (13%) moderately adherent; and 15 (23%) non-adherent. In the non-adherent group compared to the adherent group, the clinicianrated opioid withdrawal scale score was significantly higher, and the daily buprenorphine dose at last visit was significantly lower.Conclusions: : Women who were non-adherent to buprenorphine during pregnancy had higher severity of opioid withdrawal symptoms and lower doses of buprenorphine. These findings should be further explored with the goal of optimizing care without increasing risk for neonates.