–Respond to at least two of your colleagues on 2 different days who selected different disorders. Propose an alternative on-label, off-label, or nonpharmacological treatment for the disorders. Justify your suggestions with at least two references to the literature. 

–Opioid Use Disorder in Pregnant Women

According to the U.S. Department of Health and Human Services (HHS) (2021), an estimated 10.1 million people aged 12 or older misused opioids in 2019.  Of those, an estimated 7% of women reported using prescription opioid pain relievers while pregnant.  In addition, one in four women with a prescription opioid for pain indicated needing to reduce or stop the use altogether.  Shocking, over 31.9% of women who received a prescription opioid while pregnant reported not receiving provider counseling on the effects of prescription opioid use on an infant (CDC, 2021).

The treatment of opioid use disorder (OUD) during and after pregnancy can be challenging.  The provider must consider the safety of the mother as well as the infant.  The recommended first line of treatments for OUD in pregnant and breastfeeding women are buprenorphine and methadone medication-assisted treatment.  However, a recent study found that buprenorphine requires less medication to treat neonatal abstinence syndrome (NAS) symptoms and shorter hospital stay for neonates than methadone (Tran et al., 2017).

Buprenorphine is an opioid agonist drug approved by the Food and Drug Administration (FDA) to treat OUD as medication-assisted treatment (MAT). It reduces cravings to decrease opioid use, reduces effects of opioid withdrawal, and diminishes the pleasurable effects of opioid consumption (Stahl, 2017)

Naltrexone, an opioid antagonist, is also FDA approved medication-assisted treatment; however, it is not recommended for use during pregnancy due to a lack of retrospective studies. However, a recent study of 230 patients compared naltrexone use to methadone or buprenorphine, found no differences with pregnancy outcomes. In addition, for newborn outcomes, the rate of abstinence syndrome in neonates greater than 34 weeks gestation was significantly lower among patients treated with naltrexone medication-assisted treatment (Towers et al., 2020). Thus, for pregnant women who choose to detoxify off opioid drugs during pregnancy, naltrexone is a viable medication-assisted treatment option to prevent relapse in pregnant women. 

Clonidine is FDA approved for treating essential hypertension and ADHD; however, it is used off-label to alleviate opioid withdrawal symptoms.  A randomized study revealed that Clonidine improves MAT efficacy by reducing stress or cue-induced craving for heroin (Sofuoglu et al., 2018).

Recommended non-pharmacological intervention for OUD is individual or group cognitive-behavioral therapy.  For OUD, MAT is the recommended first-line treatment and CBT to ensure patient medication compliance, address comorbidities, and learn new coping skills.  A recent study evaluated treatment outcomes for patients who received MAT only to that of MAT & CBT intervention.  The study revealed that MAT & CBT combine intervention had better abstinence outcomes (Moore et al., 2016).

References

CDC. (2021, July 20). About opioid use during pregnancy. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/pregnancy/opioids/basics.html

HHS. (2021, February). Opioid crisis statistics. Retrieved from U.S. Department of Health and Human Services: https://www.hhs.gov/opioids/about-the-epidemic/opi…

Moore, B. A., Fiellin, D.A., Cutter, C. J., Buono, F. D., Barry, D. T., Fiellin, L. E., O’Connor, P. G., & Schottenfeld, R. S. (2016). Cognitive-behavioral therapy improves treatment outcomes for prescription opioid users in primary care buprenorphine treatment. Journal of substance abuse treatment, 71, 54-57. doi:10.1016/j.jsat.2016.08.016

Sofuoglu, M., Devito, E. E., & Carroll, K. M. (2018). Pharmacological and behavioral treatment of opioid use disorder. Psychiatric Research & Clinical Practice, 1(1), 4-15. doi:10.1176/appi.prcp.20180006

Stahl, S. M. (2017). Stahl’s Essential Psychopharmacology Prescriber’s Guide (6th ed.). New York: Cambridge University Press.

Towers, C., Katz, E., Weitz, B., & Viconti, K. (2020). Use of naltrexone in treating opioid use disorder in pregnancy. American Journal of Obstetrics and Gynecology, 222(1), 83.e1-83.e8. doi:10.1016/j.ajog.2019.07.037

Tran, T. H., Griffin, B. L., Stone, R. H., Vest, K. M., & Todd, T. J. (2017). Methadone, Buprenorphine, and Naltrexone for the treatment of opioid use disorder in pregnant women. Pharmacotherapy, 37(7), 824-839. doi:10.1002/phar.1958.Epub2017Jul2.