DataSheet_1_Opioid Addiction/Pregnancy and Neonatal Abstinence Syndrome (NAS): A Preliminary Open-Label Study of Buprenorphine Maintenance and Drug Use Targeted Psychotherapy (DUST) on Cessation of Addictive Drug Use.pdf

BackgroundNeonatal abstinence syndrome (NAS) is common, expensive, and hurts opioid addicted women and their families. Current treatments do not sufficiently address comorbid addictions, especially tobacco use, among pregnant buprenorphine-maintained women.
Methods25 consecutive admissions of pregnant, opioid addicted women were treated with buprenorphine maintenance and a novel intervention for pregnant opioid addicted patients, Drug Use Targeted Therapy (DUST). DUST entails a combination of informing women about the impact of various drugs on their fetus, discussing the woman’s thinking about these consequences of drug use, and varying the frequency of psychotherapy; increasing if addictive drugs are used and decreasing if the woman wishes when drug use is stopped.
Results20/25 remained in treatment until delivery. All 20 women were using addictive drugs at admission. None were planned pregnancies. There was a high prevalence of emotional, physical or sexual abuse, criminal behavior, comorbid psychiatric disorders, and chronic pain. Nineteen stopped all addictive drugs. NAS was present for 5 out of 19 newborns with a duration of hospitalization from 4 to 6 days.
ConclusionsThis preliminary open-label case series found that pregnant buprenorphine maintained women can stop tobacco. What has sometimes been termed “neonatal opioid abstinence syndrome” may most accurately be termed, “neonatal opioid/tobacco abstinence syndrome.” If the treatment effectively addresses tobacco use, other addictive drugs are rarely used. DUST resulted in a 95% quit rate for addictive drugs. Pilot data on this new intervention is limited; a case series that does not have a corresponding control group.

背景
新生儿戒断综合征（Neonatal Abstinence Syndrome, NAS）较为常见、治疗成本高昂，会对阿片类成瘾孕妇及其家庭造成损害。当前针对接受丁丙诺啡维持治疗的怀孕阿片类成瘾女性的治疗方案，无法充分解决其共病成瘾问题，尤其是烟草使用情况。
方法
本研究纳入25名连续入院的怀孕阿片类成瘾女性，均接受丁丙诺啡维持治疗，同时辅以针对怀孕阿片类成瘾患者的新型干预方案——药物使用靶向治疗（Drug Use Targeted Therapy, DUST）。该干预方案结合以下内容：向女性告知各类药物对胎儿的影响，与女性探讨其对药物使用后果的认知，并动态调整心理治疗的频次——若患者使用成瘾性药物则增加频次，若患者停止用药且有意愿则减少频次。
结果
25名受试者中有20名完成治疗直至分娩。入院时，这20名女性均存在成瘾性药物使用行为，且均为非计划妊娠。该群体中情绪、躯体或性虐待、犯罪行为、共病精神障碍及慢性疼痛的患病率较高。19名患者完全停止了成瘾性药物使用。19名新生儿中有5名出现新生儿戒断综合征，住院时长为4至6天。
结论
本项初步开放标签病例系列研究发现，接受丁丙诺啡维持治疗的怀孕女性能够戒除烟草使用。以往有时被称为“新生儿阿片类戒断综合征”的病症，更准确的命名应为“新生儿阿片类/烟草戒断综合征”。若该治疗方案能够有效解决烟草使用问题，则患者极少再使用其他成瘾性药物。药物使用靶向治疗的成瘾性药物戒断率达到95%。该项新型干预方案的先导数据仍较为有限，本研究属于无匹配对照组的病例系列研究。