Research Question
The researchers conducting this study wanted to know which opioid dependence treatment, buprenorphine or methadone, has the smallest potential for causing neonatal abstinence syndrome (NAS) in newborns.
Rationale for Treatment Methadone is typically given to treat opioid dependence. This drug, which is a mu-opioid agonist, works by limiting withdrawal symptoms and the desire to use opiates. However, methadone has been shown to have a high incidence of causing neonatal abstinence syndrome (NAS) in the child. This leads severe problems in the infant such as, hyperirritability of the central nervous system, autonomic system malfunction, respiratory disorders, and others. NAS results in longer hospitalization and more
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The independent variables in this study were buprenorphine and methadone and the dependent variables were the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, the length of the hospital stay for the neonates, and neonatal head circumference.
Discussion
The main threats identified in the study fall under the historical category. The study began with 175 participants beginning treatment, but only 131 women finished the study; 28 women on buprenorphine and 16 women on methadone dropped out of the study, showing distinctly different rates of attrition. As a result, the outcomes of the study could have shown bias in favor of the buprenorphine group. However, statistically, there were no significant between-group differences in women who completed the study and those who did not, suggesting that the differences in attrition rates are unlikely to explain the outcomes. The authors of the study explicitly addressed this concern and stated that the results should, “Be considered in light of the markedly different rates of attrition” (Jones, et al, 2010, p. 2330). They also discussed possible reasons for the differences in attrition rates and said that the rates should not matter as the final analysis conducted excluded women who were on over 100 mg of methadone, removing 19% of the sample. In terms of subject maturation, testing, and instrumentation, there are no
Substance abuse during pregnancy can have a negative force on the health and wellness of not only the fetus, but that of the mother. The harmful effects of medications, alcohol and illegal drugs on an unborn child can be devastating and can have significant consequences to its use. Sometimes the effects can be faced and treated, and other times the outcome is a lifelong challenge. During the prenatal period, it is important that new mothers are informed of the different types of abuse, how they may affect the fetus, and the adverse conditions their child may be faced with before and after birth.
The use of controlled substances throughout pregnancy is a very prevalent issue among society today. Controlled substances have devastating effects on not only the mothers using the substances, but also infants while they are in utero and after they are born. Many infants born to mothers, who are abusing drugs, suffer from life threatening illnesses and are forever affected through adulthood. Specifically, heroin is a common drug form that is often used during pregnancy and results in the life threatening effects mentioned above.
MethadoneMethadone is a far-reaching-histrionism opioid dosage. Unlike recreational drug, junk, oxycodone, and other habit-forming opioids that continue in the conceive and extent for only a lacking tempo, methadone has outcome that last for days. Methadone origin suspension, but—inasmuch as of its steadier control on the mu opioid receptors—it generate least toleration and allay desire and compulsive dope application. In title, methadone therapeutics watch to renormalize many aspects of the hormonal disruptions found in give individuals (Kling et al., 2000; Kreek, 2000; Schluger et al., 2001). For exemplify, it temperate the outré hydrocortisone accent answer (scatter above) that enhance the control of revert in stressful situations.Methadone manipulation subject regression degree, aid
Even though Methadone and Suboxone both treat opiate addiction, their use is controversial; however the benefits of their use outweigh the controversy. Especially the benefit of thousands of healthy drug free babies born to mothers that are opiate addicts, but had the choice for Methadone treatment daily, to give their unborn child the chance to be born
The National Health Institute (NIH) explains that addictive drugs such as amphetamines, cocaine, barbiturates, diazepam, and opiates consumed during pregnancy pass from mother to the fetus by crossing the placenta. This causes the baby to become addicted to these drugs along with the mother. Once born, the newborn no longer receives these drugs which then results in NAS (“Neonatal abstinence syndrome”, 2012a).
America has a major problem with opioid addicts, and many facilities are helping the addicts by providing safer options to taking the drugs their bodies crave. Methadone clinics are places where people addicted to opioids can receive medicine-based therapy. Opioid use, drugs such as heroin, morphine, and prescribed painkillers, has increased in the US with all age groups and incomes. People become addicted to these drugs when they are prescribed, recreationally used with other addicts, or they are born addicted. Many health institutions are addressing this issue with an estimated 2.1 million people in the United States suffering from substance use disorders related to prescription opioid pain relievers in 2012 and an estimated 467,000 addicted
Methadone is a synthetic opioid drug which was first used in World War II for the treatment of pain. Since then, methadone has become a popular choice for treating those addicted to other opioid drugs such as heroin, oxycodone, morphine, and hydrocodone. It is used to reduce dependency and the treatment should help them become clean. Even though, the policy of giving methadone to drug addicts is not a cure, it is a good one. Fortunately, the Methadone Maintenance Treatment (MMT) is a reliable way for those with an opioid addiction to stop and not restart the use of opioids. For many, methadone treatment provides an opportunity to regain balance in both lifestyle and priorities. (“Opiate Addiction and Treatment Resource”). Everyone deserves
“Every 25 minutes, 1 baby is born suffering from opiate withdrawal. Newborns with neonatal abstinence syndrome (NAS) are more likely than other babies to also have low birth weight and respiratory complications” (Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome, 2015, Paragraph 2). To insure a better life for these babies, people are trying to create an Act called the Plan of Safe Care Improvement or otherwise known as the Infant Plan of Safe Care Improvement. This Act is meant to protect future babies from not only being born drug dependent because of their mothers, but also ensuring them a drug-free environment after birth. It will also “get help for the mothers and any other guardians involved in drug addiction”
In the video Opiate Addiction: Understanding Replacement Therapy, Scott Farnum talks about methadone replacement therapy. There were many topics covered in this video and the topics were introduced in a psychoeducational format. The topics covered included a brief history opioids, brain chemistry, post acute withdrawal syndrome, abstinence based treatment programs verses harm reduction, and how an individual asses the damages of opioids on the brain. As a counselor in training, I found all the information useful because I have not studied methadone replacement therapy in detail.
This process consists of 6 components: assessment, diagnosis, planning outcomes, planning interventions, implementation, and evaluation. Assessment was conducted in the study by the researchers finding eligible mothers who were misusing prescribed substitute methadone during pregnancy (McGlone et al., 2013) and those who did not abuse any drugs. Once they finished with the assessment, diagnosis was applied to find out the other drugs the mothers were abusing with blood test and analyzing the infant meconium, and to make sure that their control group had healthy, drug free infants. They also implemented an exclusion criteria for the diagnosis which includes birth before 36 completed weeks’ gestation, congenital ocular abnormality, significant neonatal illness, and infants <36 weeks’ gestation. Planning outcomes includes the researcher’s hypothesis that there would be an adverse effect on the neonatal flash VEPs and there would be some sort of relationship between visual electrophysiology and subsequent neonatal abstinence syndrome (McGlone et al., 2013). Next step is planning intervention and this was done by assessing the drugs that each mother abused during their pregnancy in order to see if these drugs had an effect on the flash VEP instead of solely methadone. Implementation was not used in this research due to the fact that researchers were trying to see the relationship between prescribe methadone and flash VEP. Last step in the nursing process is evaluation which is the results that the researcher acquired from the study. Now this research was not conducted by nurses but the nursing process can be applied to it to show how this process is indirectly applied across the
In the study it is also mentioned that the "Poisson regression analyses were conducted for the total amount of morphine needed to treat NAS, neonatal length of stay in the hospital, number of days of treatment for NAS, estimated gestational age at delivery, amount of money earned for drug-negative tests, number of prenatal obstetrical visits, and Apgar scores at 1 minute and 5 minute" (Arria, et., 2010). This statistical analysis was not mentioned under statistical analysis techniques used as
In today’s society people are talking about babies being born to drugs, and how could a mother do that to their unborn child. Drug addiction is a very serious issue that needs more research. We are still learning the effects of substance abuse. One problem that needs to be looked at is are there enough Rehabilitation Centers, to help the women who are addicted to these different street drugs. Also doctor and nurses should not judge these women but instead give them the best prenatal care that can be provided. We need to see what harm and side affects it has on the mother and baby, so that we can be able to understand better how to treat these women and get them off drugs before they do harm their babies.
The use of opioids during pregnancy has increased drastically over recent years, causing newborns to fall victim to the opioid crisis. It has now become an epidemic, affecting people in the United States and globally making it a major health concern. A vast percentage leading to the opioid crisis is due to women in their childbearing stages of life. Newborns born to women addicted to opioids suffer through a form of newborn drug withdrawal known as Neonatal abstinence syndrome (NAS), resulting in increased admission rates, prolonged length of stay in the hospital and infants often require medication to recover. NAS is a result of opioid exposure in utero characterized by “central nervous system hyperirritability and autonomic nervous system dysfunction” (Kraft et
(2010) explains that although methadone is used for opioid exposure especially during pregnancy, but also is linked to NAS when a fetus is exposed to methadone. With their focus of the effects of NAS on the central nervous system hyperirritability and autonomic nervous system dysfunction Jones et al. also focused on the different effects of methadone versus those of buprenorphine, which has less substantial research. The points of study included number of newborns requiring treatment for NAS, peak score on a NAS scale, amount of morphine given through out treatment, length of hospital stay and the head circumference. Overall they only found significant differences in outcomes for the total morphine required as well as the length of the neonates hospital stay. When exposed to buprenorphine prenatally the newborns required 89% less morphine during treatment and 43% less time in the hospital than those exposed to methadone (Jones et al.,
The purpose of the Standardized Methadone Wean Protocol for NAS is to initiate a standard treatment protocol for infants admitted to RNICU & CCN with a diagnosis of NAS that require pharmacological management of their symptoms. The process will begin by identifying those infants that require pharmacological management by accessing maternal history and Modified Finnegan Scores. A Modified Finnegan Score (see Appendix F) is a standardized scoring system such as the system developed by Finnegan and later modified by Jansson and others that is used to assess the signs and severity of withdrawal in infants (Finnegan, 2013; Finnegan, & Kaltenbach, 1992; & Jansson, Velez, & Harrow, 2009). RNICU & CNN use a modified version of the Finnegan