Buprenorphine Use in Pregnant Opioid Users: A Critical Review.

CNS Drugs. 2013 Jun 18;
Soyka M

Pregnancy in opioid users poses a number of problems to treating physicians. Most guidelines recommend maintenance treatment to manage opioid addiction in pregnancy, with methadone being the gold standard. More recently, buprenorphine has been discussed as an alternate medication. The use and efficacy of buprenorphine in pregnancy is still controversial. This article reviews the current database on the basis of a detailed and critical literature search performed in MEDLINE (206 counts). Most of the relevant studies (randomised clinical trials and one national cohort sample) were published in the last 2 years and mainly compared buprenorphine with methadone. Some studies are related to maternal outcomes, others to foetal, neonatal or older child outcomes. With respect to maternal outcomes, most studies suggest that buprenorphine has similar effects to methadone. Very few data from small studies discuss an effect of buprenorphine on neurodevelopment of the foetus. Neonatal abstinence syndrome is common in infants of both buprenorphine- and methadone-maintained mothers. As regards neonatal outcomes, buprenorphine has the same clinical outcome as methadone, although some newer studies suggest that it causes fewer withdrawal symptoms. Since hardly any studies have investigated the combination of buprenorphine with naloxone (which has been suggested to possibly have teratogenic effects) in pregnant women, a switch to buprenorphine monotherapy is recommended in women who become pregnant while receiving the combination product. These novel findings indicate that buprenorphine is emerging as a first-line treatment for pregnant opioid users.
HubMed – Methadone

[Analysis of utilization situation of harm reduction services among drug users and its impact factors].

Beijing Da Xue Xue Bao. 2013 Jun 18; 45(3): 387-91
Sun YY, Yu XM, Sun JP, Xue H, Wang G, Wang J, Wang L

To study the utilization situation of harm reduction services among drug users and to analyze the reasons of the drug users’ absence in the services as well as their evaluation of the services quality based on the gender perspective, and then to provide advice on the improvement of harm reduction services in the future.Cross-sectional surveys were carried out in four cities of Yunnan Province. The information was collected from the drug users in the drug rehabilitation centers and communities through outreach workers. The utilization of methadone maintenance treatment (MMT) and needle exchange service, the reason of the drug users’ absence in the services and the evaluation towards the convenience, acceptability, as well as services quality were all surveyed.The valid samples were 579 with sex ratio 50.8% (male) and 49.2% (female). Most of the respondents (56.3%) had an educational level of junior high school and 44.0% were single. There were 61.8% (358/579) of respondents who used to utilize MMT service with female participation rate being 57.5%, which was lower than the male one (P<0.05). And there were 58.2% (223/383) of the respondents who used to exchange needles from the outreach workers or needle exchange points with female participation rate being 52.9%, which was lower than the male one (P<0.05). The leading cause of the drug users' absence in the services was their lack of understanding about the services. Among the people who used to utilize the services, the evaluations of women were better than those of men.Drug users have a low awareness of harm reduction services and female drug users are lack of the utilization towards services. More publicity and concern on harm reduction services in the future as well as exploration of the services which better fit the traits of women and privacy protection are suggested. HubMed – Methadone

Methamphetamine use and methadone maintenance treatment: An emerging problem in the drug addiction treatment network in Iran.

Int J Drug Policy. 2013 Jun 14;
Shariatirad S, Maarefvand M, Ekhtiari H

HubMed – Methadone

New Formulation of Methadone for Opioid Dependence in France: Acceptability and Diversion/Misuse Liability.

Therapie. 2013 3-4; 68(2): 107-111
Eiden C, Léglise Y, Bertomeu L, Clavel V, Faillie JL, Petit P, Peyrière H

Background. A new formulation of methadone as capsules is marketed in France since 2008. Few data are available on the patient acceptability and the risk of misuse of this new formulation. Methods. To assess the patient acceptability after the switch methadone syrup/capsules and the diversion/misuse liability of the methadone capsule, a study through an anonymous questionnaire was conducted between March 2011 and May 2012 in two methadone centers of the region. Results. Forty-one patients (men 75.6%) participated, with a median age of 37 years [IQR: 33-43 years]. The median duration of syrup methadone maintenance therapy was 1 year [IQR: 1-3 years]. A majority of patients (80.5%) described side-effects due to the syrup formulation. Median daily dose at the switch to methadone capsules was 75 mg [IQR: 42-105 mg]. Six patients described differences in the pharmacologic effect between the two formulations. Concerning the diversion and misuse liability of methadone capsules, 26.8% of patients reported that the medication was available at the “street market”. Three patients have tried to solubilize and eight have tried to snooze it. Conclusion. All patients recognize the contribution of this new formulation concerning the use, side-effects and transport. None of them returned to the syrup.
HubMed – Methadone

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