“Try not to judge”: mothers of substance exposed infants.

MCN Am J Matern Child Nurs. 2013 Jul-Aug; 38(4): 200-5
Cleveland LM, Gill SL

To describe the hospital experiences of mothers who give birth to substance-exposed infants.Secondary analysis of data from a larger study that was focused on the experiences of Mexican-American mothers in the neonatal intensive care unit (NICU) was conducted. Semistructured interviews with five women who were recovering addicts on methadone were analyzed. Each of their infants spent time in an NICU following birth. The transcribed interviews were analyzed using qualitative content analysis.Four themes were identified: (a) “try not to judge,” (b) “scoring” the baby, (c) “share with me,” and (d) “I’m the mother here!”The quality of the relationship between the mothers and the nurses in the NICU was a crucial aspect of the mothers’ experiences and may have an effect on long-term outcomes. Women with addictions often have other significant risk factors that may further jeopardize their ability to mother; therefore, it is essential to develop a strong support network. Nurses can be instrumental in organizing resources for this population of women. Judging behaviors may have a detrimental effect on women with addictions. Maternal adaptation to the mothering role can be enhanced by making reasonable efforts to include the mother in the care of the infant.
HubMed – Methadone

Review on the demographic and social impact of methadone-medication therapy on Malaysian patients.

Pak J Pharm Sci. 2013 Jul; 26(4): 841-6
Manan MM, Ali SM, Khan MA, Jafarian S, Hameed MA

This study is an observational cross-sectional study aimed to examine the possible demographic and social characteristics of patients enrolled at the Methadone Maintenance Therapy Adherence Clinic (MMTAC) in Malaysia. Medical records from year 2009 – 2011 were Reviewed. Demographic, social characteristics and laboratory examinations such as age, gender, race, clinic attendances and urine analysis were recorded. Subjects were selected by means of convenient sampling but based on the specified inclusion and exclusion criteria. Data were analyzed by either Chi-square test, Fisher’s exact test Mann-Whitney U-test, with the limit of significance was set at p < 0.05. Demographically, this study found that the ratio of Malays, Chinese and Indian enrolled to the MMTAC program is similar to the distribution of races in Malaysia. Their starting age for drug use was between 14-35 years and the age to enrolment between 30-58 years. Socially, many are unemployed, lowly educated and married. Most are drug users with a high percentage of HCV accompanied with impaired liver function. Retention rate was 87% but illicit drug use was at 57.50%. However, percentage of employment increased significantly after therapy. The study managed to identify several demographical and social distributions of patients attending the MMTAC. Although attendance rate was high, many were on illicit drug use. Nevertheless, employment rate improved significantly. HubMed – Methadone

Using chi-Squared Automatic Interaction Detection (CHAID) modelling to identify groups of methadone treatment clients experiencing significantly poorer treatment outcomes.

J Subst Abuse Treat. 2013 Jun 27;
Murphy EL, Comiskey CM

In times of scarce resources it is important for services to make evidence based decisions when identifying clients with poor outcomes. chi-Squared Automatic Interaction Detection (CHAID) modelling was used to identify characteristics of clients experiencing statistically significant poor outcomes. A national, longitudinal study recruited and interviewed, using the Maudsley Addiction Profile (MAP), 215 clients starting methadone treatment and 78% were interviewed one year later. Four CHAID analyses were conducted to model the interactions between the primary outcome variable, used heroin in the last 90days prior to one year interview and variables on drug use, treatment history, social functioning and demographics. Results revealed that regardless of these other variables, males over 22years of age consistently demonstrated significantly poorer outcomes than all other clients. CHAID models can be easily applied by service providers to provide ongoing evidence on clients exhibiting poor outcomes and requiring priority within services.
HubMed – Methadone

Double jeopardy.

Indian Heart J. 2013 May-Jun; 65(3): 315-8
Cullington D, Dunford N, Beer S, Hobson N, Chattopadhyay S, John J

Torsades de pointes (“twisting of points”) (TdP) is a broad complex tachyarrhythmia which was first described in 1966 by Francois Dessertenne and usually results from prolongation of the QT interval.(1) A wide variety of drugs have been shown to prolong the QT interval in susceptible individuals.(2) We present the case of a former intravenous heroin user presenting with several episodes of TdP which were caused by QT prolongation due to methadone treatment and exacerbated by hepatitis B/C infection. Despite aggressive medical treatment and withdrawal of methadone, he had recurrent episodes of TdP which required continuous temporary cardiac pacing for six days. He was found to have moderate LV dysfunction on his echocardiogram and unobstructed coronary arteries on coronary angiography. He underwent implantation of a defibrillator due to concerns about further episodes of ventricular arrhythmias which could recur even in the absence of further methadone use.
HubMed – Methadone

QTc interval prolongation for patients in methadone maintenance treatment: a five years follow-up study.

Am J Drug Alcohol Abuse. 2013 Jun 28;
Fareed A, Vayalapalli S, Scheinberg K, Gale R, Casarella J, Drexler K

Abstract Background: QTc prolongation for patients in methadone maintenance treatment (MMT) has been reported. In this study we wanted to identify the predictor factors for QTc prolongation >500?ms and other medical risk factors for mortality in this population. Methods: A retrospective chart review study with 55 patients who had previously been included in our performance improvement project and who were eligible to be reviewed. A linear regression model with one-sided p value was used for data analysis. Results: Over 5 years, 41% to 56% of patients had QTc?>?450 and <500?ms and 4% to 10% of patients had at least one reading of QTc?>?500?ms. This QTc prolongation from baseline showed statistical significance (p?500?ms. The model as a whole showed statistical significance (F?=?3.50, p?=?0.02). Being diagnosed with CHF and elevated HgA1c level was significantly associated with mortality. The model as a whole also showed statistical significance (F?=?4.63, p?=?0.01). Conclusions: This study confirms that methadone may be associated with QTc prolongation. It identified three risk factors for significant QTc prolongation for patients on MMT which are recent cocaine use, uncontrolled blood glucose and CHF. Two of these three risk facts (uncontrolled blood glucose and CHF) were associated with mortality in this cohort. Patients with these medical co-morbidities may benefit from EKG screening and aggressive treatment of the medical risk factors while taking MMT.
HubMed – Methadone

Day 20 At Home After Methadone Detox: Recovering From A Myriad Of Physical And Emotional Stresses – via YouTube Capture.

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