Addiction in Pregnancy (July/August)

Date of Issue: 07/01/2021 | Volume: 9 | Number: 4&5

Issue Links:Learning Objectives | Editorial Information

Dr. Forray reviews effects of addiction during pregnancy and the current evidence for how best to treat it. Dr. Coffin lays out the nuts and bolts of naloxone prescribing for patients with opioid use disorder. Plus, an overview of addiction and addiction treatment for women who are breastfeeding, along with research updates on adjunctive CBT.

In This Issue

Clinical Update

Breastfeeding and Addiction

Topics: Breastfeeding | childcare | infant | lactation | newborn

Addictive substances and medications alike can find their way into the breastmilk of lactating women, however the effect these substances have on breastfeeding babies can vary. We provide guidance on how best to manage addiction in women who are actively breastfeeding.

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Expert Q&A

The Pregnant Patient With Substance Use Disorder

Topics: Addiction Treatment | fetal effects | Pregnancy

Dr. Forray gives readers a comprehensive refresher on fetal effects of alcohol, tobacco, opioid, cannabis, and stimulant use during pregnancy. She then lays out the current evidence for various treatments and provides recommendations for how to treat pregnant patients with addiction.

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Expert Q&A

Naloxone Prescribing

Topics: Harm reduction | Naloxone | Opioid epidemic | Opioid Use Disorder

Dr. Coffin provides our readers with everything there is to know about the nuts and bolts of naloxone prescribing for opioid use disorder. He tells us how patients can get their hands on naloxone, reviews the pros, cons, and costs of various naloxone formulations, and covers current naloxone laws.

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News of Note

A New High-Dose Naloxone: Life Saver or Punishment?

Topics: Harm reduction | Naloxone | Opioid Use Disorder

The FDA recently approved a nasal spray formulation of naloxone. Called Kloxxado, each spray delivers 8mg, twice as much as the most widely used formulation, Narcan. Whether or not this higher dose is necessary, is debatable.

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Research Update

Does CBT Enhance Pharmacotherapy for Addiction?

Topics: Adjunct treatment | Cognitive Behavioral Therapy | Psychotherapy

Psychotherapy has had a mixed track record of efficacy for substance use disorders. This meta-analysis suggests that CBT is only modestly effective when combined with medications and likely no better than any other form of therapy. Although it’s unlikely be a magic bullet, CBT is very low risk, and reasonable to offer alongside other more established treatments.

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Research Update

Starting Buprenorphine: Is Timing Everything?

Topics: Buprenorphine | Dosage Timing | Opioid Use Disorder

When is an optimal time to start buprenorphine in order to keep patients in treatment? In this retrospective study, researchers compared treatment retention as a function of whether or not buprenorphine was prescribed on the day of initial evaluation. Same day prescription trended non-significantly towards improved retention.

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Research Update

Cannabidiol for Crack-Cocaine Craving: Negative Findings

Topics: Addiction Treatment | Cannabidiol | Cocaine | craving

Cocaine use disorder is notoriously difficult to treat. The authors of this study asked, might cannabidiol be helpful in treating the cravings that prompt cocaine use? While this might seem like an unusual question at first, there is some supportive preclinical data that makes the premise plausible. Unfortunately, the results were negative in this small study.

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Research Update

Nicotine Patch for Cannabis Withdrawal?

Topics: Cannabis | nicotine | Withdrawal

As cannabis use becomes more widespread, treaters will inevitably see increases in patients reporting symptoms of cannabis withdrawal. Researchers in this study investigated whether a nicotine patch might help mitigate some of these symptoms. Results were not particularly promising, and should only be considered for patients who also use tobacco.

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CME Post-Test

CME Post-Test - Addiction in Pregnancy, CATR, July/August 2021

Topics: CME Post-Test

The post-test for this issue is available for one year after the publication date to subscribers only. By successfully completing the test you will be awarded a certificate for 2 CME credits.

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