LAAM MAINTENANCE--PERINATAL, SHORT, AND LONG TERM EFFECTS

尽管与美沙酮维持疗法相比，美沙酮具有一些明显的优势 继续为怀孕的海洛因成瘾者使用海洛因，例如，更好的产前 照顾，较大的婴儿，它有每天需要的缺点 管理诊所以避免戒断症状和转移注意力 带回家的剂量。此外，在宫内暴露于美沙酮的婴儿有 中到重度戒断症状和表现的高发 各种神经行为缺陷。左旋α-乙酰美沙醇(LAAM)， 每周服用三次的长效鸦片类药物可能更好。 维持治疗。我们假设LAAM将产生更少的 重度新生儿戒断综合征较美沙酮易感患者 合规性。目前还没有关于LAAM的信息 怀孕期间的倾向或其对新生儿的可能影响。这 项目将决定排泄和排泄的半衰期 不同时期LAAM及其活性代谢物的变化规律 新生儿的怀孕、分娩时和分娩后。贯穿始终 妊娠、用药问卷和尿毒学筛查 都会完成的。在出生时，异常将由身体和 神经学检查。将进行布拉斯尔顿行为评估 以评估响应性。戒断综合征的体征和症状 将在医院和出院后每天进行评估，为期8周。 LAAM消失率将与发病率和严重程度相关 禁欲。 在6、9、12、 15个月、21个月和24个月。为了确定神经行为发育，一个 神经学检查和贝利智力运动发育量表将 每隔六个月给药一次。此外，结构化的 对产妇功能和产妇抑郁症状的评估将 被执行。还将实施家庭评估量表。 将使用多变量分析来确定 LAAM和其他药物滥用、围产期和产妇心理社会 变量和神经发育结果。LAAM的分组比较 对抗美沙酮也将被制造出来。 这项研究将确定药物的疗效、处置和效果 怀孕期间服用LAAM的孕妇与美沙酮的对比以及 后代的身体和神经发育。利用这些信息， 可以设计进一步的研究，并可能制定干预计划 发展起来的。

Although methadone maintenance has some distinct advantages compared to continued heroin use for pregnant heroin addicts, e.g., better prenatal care, bigger infants, it has the disadvantages of needing daily administration of a clinic to avoid withdrawal symptoms and diversion of take-home doses. Further, infants exposed to methadone in utero have a high incidence of moderate to severe abstinence symptoms and display various neurobehavioral deficiencies. Levo-alpha-acetylmethadol (LAAM), a long-acting opiate which is given three times a week, may be a better maintenance treatment. We hypothesize that LAAM will produce a less severe neonatal abstinence syndrome than methadone and facilitate patient compliance. At present there is no information regarding LAAM's disposition in pregnancy or its possible effects on the neonate. This project will determine the half life of elimination and excretion patterns of LAAM and its active metabolites during various periods of the pregnancy, at delivery, and after delivery in the neonate. Throughout the pregnancy, drug use questionnaires and urine toxicology screening will be done. At birth, abnormalities will be determined by physical and neurological exam. A Brazelton Behavioral Assessment will be performed to assess responsiveness. Signs and symptoms of an abstinence syndrome will be evaluated daily in the hospital and after discharge for 8 weeks. Rates of LAAM elimination will be correlated to incidence and severity of abstinence. Follow-up evaluations of the infants will be done repeatedly at 6, 9, 12, 15, 21 and 24 months. To determine neurobehavioral development, a neurological exam and the Bayley Scales of Mental Motor Development will be administered at six month intervals. Additionally, structured assessments of maternal functioning and maternal depressive symptoms will be performed. HOME assessment scale will also be administered. Multivariate analysis will be employed to determine relationships between LAAM and other drugs abused, perinatal and maternal psychosocial variables and neurodevelopmental outcome. Group comparisons of LAAM versus methadone will also be made. This study will determine the efficacy, disposition, and effects of pregnant women on LAAM versus methadone during pregnancy as well as the physical and neurodevelopment of the offspring. Using this information, further studies can be designed and intervention programs may be developed.