Ingunn Olea Lund

A Comparison of Buprenorphine + Naloxone to Buprenorphine and Methadone in the Treatment of Opioid Dependence during Pregnancy: Maternal and Neonatal Outcomes:

Given that buprenorphine + naloxone is prescribed for opioid-dependent pregnant women, it is important to examine the extent to which it differs from buprenorphine alone, methadone, or methadone-assisted withdrawal on neonatal and maternal outcomes. Summary statistics on maternal and neonatal outcomes were collected from 7 previously published studies examining treatment for opioid-dependent pregnant women that represented a range of research methodologies. Outcomes from these studies were compared to the same outcomes for 10 women treated with the combined buprenorphine + naloxone product. There were no significant differences in maternal outcomes for buprenorphine + naloxone compared to buprenorphine, methadone, or methadone-assisted withdrawal. Preliminary findings suggest no significant adverse maternal or neonatal outcomes related to the use of buprenorphine + naloxone for the treatment of opioid dependence during pregnancy. However, further research should examine possible differences between buprenorphine + naloxone and buprenorphine alone or methadone in fetal physical development.

Prescription drug use among pregnant women in opioid Maintenance Treatment

AIMS This study describes the use of prescribed drugs among women in opioid maintenance treatment (OMT) prior to, and during, pregnancy. DESIGN This cohort study was based on data from two nationwide databases: the Medical Birth Registry of Norway and the Norwegian Prescription Database. SETTING Norway, 2004-2010. PARTICIPANTS OMT drugs were dispensed to 138 women with 159 pregnancies. MEASUREMENTS All prescription drugs dispensed to women in OMT three months prior to, and during, pregnancy were studied. Amounts of benzodiazepines, z-hypnotics and opioid analgesics dispensed during pregnancy were studied and bivariate analysis was used to study neonatal outcomes of OMT pregnancies with and without such co-medication. FINDINGS The prevalence of prescription drug use by pregnant OMT women was high both during the three-month period prior to (69%), and during (81%), pregnancy. The proportion of pregnant women that was dispensed anti-infectives (48%) and/or drugs acting on the nervous system (45%) during any time in pregnancy was especially high. In 21%, 15% and 13% of the pregnancies the women were dispensed benzodiazepine anxiolytics, opioid analgesics or benzodiazepine hypnotics respectively. Only 5% of the OMT women were dispensed antidepressants. Malformations were significantly more common among children born to mothers in OMT that received co-medication with opioids, benzodiazepines or z-hypnotics. CONCLUSIONS A higher proportion of women in opioid maintenance treatment in Norway use prescription drugs prior to, and during, pregnancy than pregnant women in the general population. Co-medication with drugs with abuse potential may increase the risk of adverse pregnancy outcomes and this need to be further addressed.

Substance use during and after pregnancy among a national cohort of pregnant women in opioid maintenance treatment and their partners

Background: Most individuals in opioid maintenance treatment (OMT) have had serious polydrug problems in addition to opiate addiction. Prospective studies on substance use among pregnant women in OMT and their male partners on a national level have been scarce and therefore deserve attention. Methods: The European Addiction Severity Index was used to map substance use history among a Norwegian national cohort (2005–2006) of pregnant OMT women (n = 37) and their partners (n = 23), as well as substance use during the last month of pregnancy and 1 year later. Results: Lifetime substance use indicated an average of 8 years of heroin abuse before entering OMT. During the last month of pregnancy one woman and two partners reported using illegal substances, while 1 year later, one women and one partner reported having used illegal substances. The use of legal substances among the partners was significantly reduced from pregnancy to 1 year later (38–20%, p < 0.01), while the use of legal substances among the women increased from 8% to 19%. Conclusion: The results suggest that a majority of OMT mothers in Norway and their partners are able to abstain from most illegal substances 1 year after pregnancy, but the tendency of problem drinking among the women is a concern.

comparing methadone and buprenorphine maintenance with methadone-assisted withdrawal for the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes

Pregnancy can motivate opioid-dependent women to seek substance abuse treatment. Research has demonstrated that although prenatal exposure to buprenorphine results in less severe neonatal abstinence syndrome (NAS) relative to prenatal methadone exposure, the maternal and other neonatal outcomes are similar for the two medications. Maternal and neonatal outcomes for opioid-dependent pregnant women receiving these medications have not been systematically ompared with methadone-assisted withdrawal. The present study provides an initial assessment of the relative efficacy of both methadone and buprenorphine maintenance versus methadone-assisted withdrawal in terms of neonatal and maternal delivery outcomes. Data were derived from (1) the MOTHER (Maternal Opioid Treatment: Human Experimental Research) study at the Johns Hopkins University Bayview Medical Center (JHBMC), or (2) retrospective records review of women who underwent methadone-assisted withdrawal at the JHBMC during the time period in which participants were enrolled in the MOTHER study. Compared with the methadone maintenance group, the methadone-assisted withdrawal group had a significantly lower mean NAS peak score (Means = 13.7 vs 7.0; P = 0.002), required a significantly lower mean amount of morphine to treat NAS (Means = 82.8 vs 0.2; P < 0.001), had significantly fewer days medicated for NAS (Means = 31.5 vs 3.9; P < 0.001), and remained in the hospital for a significantly fewer number of days, on average (Means = 24.2 vs 7.0; P < 0.019). Compared with the buprenorphine maintenance group, the methadone-assisted withdrawal group required a significantly lower mean amount of morphine to treat NAS (Means = 8.2 vs 0.2; P < 0.001) and significantly fewer days medicated for NAS (Means = 12.0 vs 3.9; P = 0.008). Findings suggest that it is possible for some opioid-dependent pregnant women to succeed with methadone-assisted withdrawal. Future research needs to more fully evaluate the potential benefits and risks of methadone-assisted withdrawal for the maternal-fetal dyad.

A 2-year prospective study of psychological distress among a national cohort of pregnant women in opioid maintenance treatment and their partners

Background: The prevalence of psychological distress among persons in opioid maintenance treatments (OMT) is high. It is important to assess psychological distress among OMT mothers and their partners because such psychological distress increases the risk of relapse to substance use. Methods: A national cohort of pregnant women in OMT (n = 37) and their partners (n = 23) were taking part in a prospective study. They were interviewed during third trimester of pregnancy and 1 year after giving birth with the European Addiction Severity Index and completed Symptom Checklist 25 during the last month of pregnancy, 6 months and 2 years after the children were born. Results: Among the women there was a significant reduction in depressive symptoms from pregnancy to 6 months after giving birth (p < 0.01) and an increase in depressive symptoms from 6 months to 2 years after giving birth. Among the partners there was a significant decrease in psychological distress from pregnancy to 1 year after the children were born (p < 0.05). Conclusion: The overall results indicate a reduction in psychological distress for both OMT women and their male partners during the first period after birth, probably affecting parenting abilities and treatment outcome in a positive way.

Experienced Harm from Other People's Drinking: A Comparison of Northern European Countries.

Objective This study addresses how experienced harm from other peoples drinking varies between six Northern European countries by comparing 1) the prevalence of experienced harm and 2) the correlates of harm. Method The data comprise 18ȓ69-year olds who participated in general population surveys in Denmark, Finland, Iceland, Norway, Sweden, and Scotland during the period 2008–2013. Comparative data were available on five types of harm: physical abuse, damage of clothes/belongings, verbal abuse, being afraid, and being kept awake at night. Results This study shows that harms from others drinking are commonly experienced in all six countries. Being kept awake at night is the most common harm, while being physically harmed is the least common. The proportions that reported at least one of the five problems were highest in Finland and Iceland and lowest in Norway, but also relatively low in Sweden. Across countries, the level of harm was highest among young, single, urban residents, and for some countries among women and those who frequently drank to intoxication themselves. Conclusions The study revealed large differences in the prevalence of harm in countries with fairly similar drinking cultures. However, the correlates of such experiences were similar across countries. Possible explanations of the findings are discussed, including differences in study design.

Negative consequences of other people's drinking: prevalence, perpetrators and locations

INTRODUCTION AND AIMS While both policy makers and researchers have shown renewed interest in drinking and harm to others, several questions concerning the issue remain unanswered. The aim of this study was to address some of these questions by: (i) presenting updated figures on the prevalence of experienced harm from other peoples drinking in various sub-groups; and (ii) examining in which locations such episodes most often occur and who the perpetrators usually are. DESIGN AND METHODS Data were obtained from a general population survey among 16- to 79-year-old Norwegians (n = 1947), where experiences of five negative consequences related to other peoples drinking (e.g. physical abuse and verbal abuse) were assessed. Those who reported such experiences were asked to specify at which location the last episode occurred and who the perpetrator was. RESULTS Altogether, 17.3% had experienced one or more problems during the past 12 months. Persons who were young, not living with a partner, an urban resident, with low education and often intoxicated were at increased risk. The direction of statistically significant gender differences depended on the type of problem. While the episodes were spread across different locations (private homes, on-premise outlets and outdoors), perpetrators were more often strangers or friends/acquaintances than partners or family members. DISCUSSION AND CONCLUSIONS In a preventive perspective, increased knowledge regarding the context of episodes where people experience harm from other peoples drinking is important. We have shed some light on this issue by examining the locations and perpetrators of such episodes. [Storvoll EE, Moan IS, Lund IO. Negative consequences of other peoples drinking: Prevalence, perpetrators and locations. Drug Alcohol Rev 2016;35:755-762].

A longitudinal study on substance use and related problems in women in opioid maintenance treatment from pregnancy to four years after giving birth.

Background Women in opioid maintenance treatment (OMT) have a past characterized by drug abuse, which is a challenging start for parenthood. Studies of mothers in OMT are typically limited to pregnancy and early infancy. Knowledge about how they cope with substance use and related problems in the years following birth is therefore important. The aims of the study were to examine changes in mothers’ substance use, psychological problems, and other challenges; from one to four years after their children were born, and describe kindergarten attendance and prevalence and type of child protective services involvement when the children were four years old. Method A four-year prospective cohort study of mothers in OMT. The European severity index was used to map substance use and related problems during the third trimester of pregnancy, one and four years after birth. Results At the four-year follow-up, use of illegal substances remained low (4%) and use of legal substances (39%) was similar to the one-year follow-up. The proportion of women with psychological problems was significantly higher than at one-year follow-up (69 vs. 39%, P = .009). At age four, most children (89%) attended kindergarten, and the child protective services were following 73% of the families, mostly with voluntary measures. Conclusion Mothers in OMT cope well with substance use over time, given access to sufficient support. The findings imply that a preventive governmental strategy with close support of mother and child, have a positive impact contributing to making OMT and motherhood more compatible.

Harm Experienced from the Heavy Drinking of Family and Friends in the General Population: A Comparative Study of Six Northern European Countries.

Background Epidemiological research on alcohol-related harm has long given priority to studies on harm to the drinker. A limitation with this perspective is that it neglects the harm drinking causes to people around the drinker, and thus, it fails to give a full picture of alcohol-related harm in society. Aim The aim was to compare the prevalence and correlates of experiencing harm from the heavy drinking by family and friends across the Nordic countries and Scotland and to discuss whether potential differences match levels of drinking, prevalence of binge drinking, and alcohol-related mortality. Data and Method Data from recent national general population surveys with similar questions on experiences of harms from the drinking of family and friends were collected from Sweden, Finland, Denmark, Norway, Iceland, and Scotland. Results National estimates of the overall population prevalence of harm from the drinking of family and friends ranged from 14% to 28% across these countries, with the highest prevalence in Finland, Iceland, and Norway and lower estimates for Denmark, Sweden, and Scotland. Across all countries, the prevalence of harm from heavy drinking by family and friends was significantly higher among women and young respondents. Conclusion This study revealed large differences in the prevalence of harm across the study countries, as well as by gender and age, but the differences do not match the variation in population drinking and other indicators of harm. The implications of the findings for future research are discussed.

Associations between risk judgments and demand for transport risk mitigation

The present study tested a hypothesized model regarding associations between risk sensitivity, risk perception, transport priorities, worry, and demand for risk mitigation in transport. An additional aim was to investigate differences in risk perception, worry, risk sensitivity, transport priorities, and demand for risk mitigation in age-groups, gender, and educational levels. A mail survey was conducted in a representative sample of the Norwegian public over 18 years (n = 1947) in 2008. The response rate was 31%. The results showed that transport priorities were the strongest predictor of demand for risk mitigation. Risk perception seems to be mediated by worry. Risk sensitivity was directly associated with transport risk perception and, not as predicted, also directly with demand for risk mitigation. The two youngest age-groups (18–30 and 31–50 years) perceived the probabilities of transport accidents in private transportation as significantly larger and also judged other nontransport risks to be larger than those over 50 years of age. The youngest age-group was more worried about injuries from private transportation, but reported lower demands for risk mitigation. The findings merit further research into the relationship between risk perception and demand for risk mitigation. The results indicated that younger individuals were more worried about injuries and assessed the probability of accidents to be larger, while they report a lower demand for risk mitigation compared to older age-groups.