RESUMO
OBJECTIVE: To develop a dyadic-centered framework focused on clinical care, surveillance, and research for birthing persons with opioid use disorder (OUD) and their infants and children. STUDY DESIGN: Between February and March 2023, an analysis was conducted within the US Department of Health and Human Services (HHS) of activities directed at opioid-exposed birthing persons and their infants and children (the dyad) to identify: 1) number of activities, stratified by type and 2) characteristics across health and supportive activities that serve the dyad vs birthing persons or infants and children individually. Descriptive and thematic analyses were used to assess quantity and characteristics of fiscal year 2023-2024 activities aggregated across eleven HHS agencies. RESULTS: Of 181 activities examined, 75 met inclusion criteria specific to serving birthing persons with OUD and opioid-exposed infants and children. Sixty-two percent of activities were dyad focused. Five categories of dyadic activities were identified: research (45%), education and training (28%), health and supportive services (21%), surveillance (4%), and quality improvement (2%). Eight specific characteristics were key to dyadic activities: a life course and generational approach, emphasis on relationship, dyadic outcomes, service wraparound, payment structures supporting dyadic care, data linkage, and social determinants of health. CONCLUSIONS: This analysis of HHS activities directed at birthing persons with OUD and opioid-exposed infants and children showed that most programs had a dyadic focus. Synthesizing elements identified from activities serving the dyad facilitated the development of a dyadic framework integrating clinical care, public health surveillance, and research.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Lactente , Criança , Humanos , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/epidemiologiaRESUMO
OBJECTIVE: To standardize the clinical definition of opioid withdrawal in neonates to address challenges in clinical care, quality improvement, research, and public policy for this patient population. STUDY DESIGN: Between October and December 2020, we conducted 2 modified-Delphi panels using ExpertLens, a virtual platform for performing iterative expert engagement panels. Twenty clinical experts specializing in care for the substance-exposed mother-neonate dyad explored the necessity of key evidence-based clinical elements in defining opioid withdrawal in the neonate leading to a diagnosis of neonatal abstinence syndrome (NAS)/neonatal opioid withdrawal syndrome (NOWS). Expert consensus was assessed using descriptive statistics, the RAND/UCLA Appropriateness Method, and thematic analysis of participants' comments. RESULTS: Expert panels concluded the following were required for diagnosis: in utero exposure (known by history, not necessarily by toxicology testing) to opioids with or without the presence of other psychotropic substances, and the presence of at least two of the most common clinical signs characteristic of withdrawal (excessive crying, fragmented sleep, tremors, increased muscle tone, gastrointestinal dysfunction). CONCLUSIONS: Results indicate that both a known history of in utero opioid exposure and a distinct set of withdrawal signs are necessary to standardize a definition of neonatal withdrawal. Implementation of a standardized definition requires both patient engagement and a mother-neonate dyadic approach mindful of program and policy implications.
Assuntos
Síndrome de Abstinência Neonatal , Transtornos Relacionados ao Uso de Opioides , Distúrbios do Início e da Manutenção do Sono , Analgésicos Opioides/efeitos adversos , Feminino , Humanos , Recém-Nascido , Mães , Entorpecentes/uso terapêutico , Síndrome de Abstinência Neonatal/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológicoRESUMO
Introducción: La exposición a eventos traumáticos es muy frecuente en mujeres con problemas de abuso de sustancias, pero no todas desarrollan síndrome de estrés postraumático (SEP). Pacientes con SEP tienen más problemas médicos, problemas interpersonales, usan drogas más fuertes y son más resistentes al tratamiento de adicción que pacientes sin este trastorno. Método: Exploración de la prevalencia de SEP en 87 mujeres embarazadas en tratamiento para adicción a drogas, que reportaron historia de violencia actual o durante la vida y aceptaron evaluación e intervenciones para mejorar aspectos afectados por el trauma, usando la Escala Diagnóstica de Estrés Postraumático (PDS), y de la sintomatología psicológica asociada, usando el Cuestionario de Síntomas-90 revisado (SCL-90R). Resultados: Más de la mitad (50,6%) de las pacientes llenaron criterios diagnósticos de SEP. Las mujeres con SEP presentaron puntuaciones significativamente más altas en todas las subescalas del SCL- 90R, el Índice de Severidad Global (1,58 vs. 0,89) y el Índice de Síntomas Positivos de Distrés (2,24 vs.1,78) que las mujeres sin SEP. Conclusión: Los resultados señalan la importancia de la evaluación de trauma y sus consecuencias en las mujeres embarazadas que reciben tratamiento para el abuso de sustancias y la necesidad de implementar intervenciones más efectivas para mujeres con problemas de adicción y SEP...
Introduction: Trauma exposure is very coomon among women with substance abuse problems, but not all develop post-traumatic stress syndrome (PTSD). Patients with PTSD have more medical problems, interpersonal issues, drug use and are more resistant to addiction treatment than patients without this disorder. Method: To study the prevalence of SEP in 87 pregnant women in treatment for drug addiction, who reported current or history of violence and accepted lifetime assessment and interventions to improve areas affected by the trauma, using the Posttraumatic Stress Diagnostic Scale (PDS), and associated psychological symptoms using the Symptom Checklist Questionnaire-90 Revised (SCL-90R). Results: Over half (50.6%) of patients fulfilled criteria for PTSD. The women with PTSD scored significantly higher on all subscales of the SCL-90R, the Global Severity Index (1.58 vs. 0.89) and the Positive Symptoms Distress Index (2.24 vs.1.78) than women without PTSD. Conclusion: Results highlight the importance of assessing trauma and its consequences in pregnant women receiving treatment for substance abuse and the need to implement more effective interventions for women with addiction problems and PTSD...