Objectives. Objectives, continued 9/22/2015
|
|
- Delilah Barnett
- 8 years ago
- Views:
Transcription
1 Neonatal Abstinence Syndrome Jennifer Manning, DO Neonatologist, Akron Children s Hospital Mahoning Valley Clinical Associate Professor of Pediatrics, NEOMED September 27, 2015 Adapted from a lecture by Linda Cooper, M.D. Neonatologist, Akron Children s Hospital Mahoning Valley Clinical Assistant Professor of Pediatrics, NEOMED Objectives Define Neonatal Abstinence Syndrome (NAS) Discuss the symptoms of NAS List the drugs used by mothers Review the Ohio Dept of Alcohol and Drug Addiction Services (ODADAS ) data on drug patterns Discuss testing of newborns- urine, meconium, and cord tissue Describe Finnegan Scoring Objectives, continued Discuss non-pharmacologic and pharmacologic treatment of NAS Review our data Describe new approaches to treatment for mothers and babies 1
2 Why This Matters To You As family health care providers, you provide care for parents and their children You have the ability to influence and educate your patients resulting in healthier women and children You have an established relationship with your patients. They trust you and they will listen to you Neonatal Abstinence Syndrome A constellation of signs and symptoms of withdrawal in infants who have been exposed to maternal opiates during pregnancy These symptoms are manifested by CNS irritability, gastrointestinal disturbances, and autonomic instabilities NAS Facts % of term infants exposed to narcotics develop NAS Severity of withdrawal may not correlate with the dose or duration of exposure Infants < 34 weeks rarely develop typical symptoms of withdrawal seen in term infants The early symptoms are mostly autonomic and central nervous system irritability, followed by gastrointestinal dysfunction - American Academy of Pediatrics Committee on Drugs Pediatrics. Jan 30,
3 More NAS Facts Seizures occur in 2-10% of infants withdrawing from opioids Over 30% of infants will have abnormal EEGs without overt seizure activity Multi-drug exposure may manifest clinically with a biphasic pattern of withdrawal which include an exacerbation of symptoms 1-2 weeks after successful treatment of initial symptom Onset of Withdrawal Symptoms Substance Used Timing of Withdrawal Heroin hours Methadone/buprenorphine At birth up to 7 days Benzodiazepines 1-2 weeks CNS Signs/Symptoms Hypertonia Tremors at rest or when disturbed High-pitched or prolonged crying Extreme irritability and/or restlessness Exaggerated Moro reflex Sleep disturbances Seizures 3
4 GI Symptoms Frequent loose, watery stools Poor or ineffective feeding (chew or bite the nipple) Emesis Poor weight gain Dehydration Failure to pass stool in first day or two Autonomic Symptoms Elevated temperature Nasal stuffiness Sneezing Skin mottling Miscellaneous Symptoms Tachypnea Skin excoriation, especially on the buttocks due to loose and frequent stools Apnea- not commonly seen 4
5 Differential Diagnosis Sepsis Hypocalcemia Hypoglycemia CNS hemorrhage Meningitis Perinatal asphyxia Polycythemia Drugs of Abuse Opium Poppy 5
6 Opium History 3400 B.C. in lower Mesopotamia, Sumerians cultivated and used opium for its euphoric effects (the joy plant). They passed it on to the Assyrians, then to the Egyptians Over the centuries its reputation spread, and the trade stretched to India and China via the Silk Road The British Empire secretly smuggled it to Chinaresulting in the first Opium War of Britain won; Hong Kong was ceded to Britain Chinese immigrants brought opium to the US in the mid 1800 s with the railroad and the Gold Rush Opium Den San Francisco Heroin History London, 1874: C.R. Alder Wright synthesized first heroin from opium by adding 2 acetyl groups to the molecule (diacetyl morphine) Germany, 1897: Felix Hoffman was working for the pharmaceutical lab now known as Bayer Labs in Elberfeld, Germany Hoffman re-synthesized heroin (diacetyl morphine) in an attempt to make codeine, a less potent form of morphine Bayer named this new compound Heroin, from the Greek heros, or hero 6
7 Bayer Heroin Bottle Bayer Heroin Heroin was marketed from 1898 to 1910 as a non-addicting morphine substitute and cough suppressant It later became an embarrassment for Bayer when it was discovered that heroin was quickly metabolized to morphine A federal law banned OTC sale in 1914 Heroin was banned completely in 1924 by the US Congress Drugs of Abuse Opiates: Heroin Methadone Oxycodone(OxyContin), Morphine Codeine Meperidine Opium Vicodin(hydrocodone/acetaminophen) Buprenorphine(Subutex or Suboxone) Benzodiazepines: diazepam(valium), alprazolam(xanax), lorazepam(ativan) Barbiturates-rare in our infants Alcohol 7
8 Opana Street names: pandas, bears, panas Oxymorphone: a semi-synthetic opioid with high abuse potential Introduced in 1959 as an analgesic FDA approved immediate release(opana ) and extended-release (Opana ER) in 2006 More potent than oxycodone, hydrocodone, or morphine Substances not associated with NAS Tobacco Marijuana Cocaine Antidepressants Amphetamines SSRIs- may have toxicity symptoms Caffeine Bath Salts-designer stimulants e.g. Mephedrone and MDPV Opium Poppy with Latex 8
9 9
10 Ohio Substance Monitoring June 2013-January
11 Initial Screening and Subsequent Action Mother: Ideally, urine toxicology during pregnancy. This should include urine for opiates Mothers with positive screens should be counseled, and appropriate referrals should be made, e.g. to a drug rehab facility and also to neonatologists to discuss baby s chances of withdrawal and treatment options Subutex is preferable to methadone, but not always possible Indications to Screen for Substance Abuse Maternal Factors Known maternal substance use-either prescribed medication or street drugs Late or no prenatal care History of depression, chronic pain Incarceration Severe mood swings or bizarre behavior Indications to Screen, continued Maternal Factors Previous infant with NAS History of physical and/or sexual abuse History of STIs Previous unexplained fetal demise Preterm labor 11
12 Indications to Screen for Substance Abuse Neonates with high risk factors Prematurity Unexplained IUGR or low birthweight Abnormal CNS exam: tremors, irritability, poor state control Emesis, diarrhea, or failure to pass stool in first few days of life Infant Screening Urine for toxicology Urine for opiates (above screen does not test for oxycodone, buprenorphine, etc) Meconium toxicology- must collect all the meconium, not just one sample; reflects any exposure after 20 weeks gestation Infants with known exposure should remain in hospital for 5 days to assess for neonatal abstinence CordStat A relatively new drug test that utilizes umbilical cord tissue as the sample matrix Universal Noninvasive, simple to collect Allows for a higher level of sensitivity for specific drugs Faster turnaround time than meconium screen USDTL.com 12
13 Cord Tissue Testing A study in Utah of 100 umbilical cord samples demonstrated the ability to assay cord tissue for drugs of abuse Enzyme-linked immunosorbent assay (ELISA) was compared to gas or liquid chromatography mass spectrometry Categories: opiates, cocaine, amphetamines, cannabinoids and PCP Results: > 90% agreement between paired specimens Montgomery, et.al. Journal Perinatology 2006 Cord Tissue Testing Follow-up study in Utah and New Jersey 498 umbilical cord samples Results: > 90% agreement between paired specimens Montgomery, et al. Journal of Perinatology, July 2008 CordStat Amphetamines Barbiturates Buprenorphine Benzodiazepines Cannabinoids Cocaine Methadone Meperidine Opiates Oxycodone PCP(Phencyclidine), angel dust Propoxyphene (Darvon, discontinued) Tramadol 13
14 Cordstat Add-ons Ethyl glucuride Designer stimulants (bath salts) Cotinine CordStat The opiate screen includes: Codeine Morphine Hydrocodone Hydromorphone 6-MAM (heroin metabolite) 14
15 The Finnegan Score for Neonatal Abstinence A tool developed by Loretta Finnegan, M.D. in 1975 It provides a quantitative measure of the severity of withdrawal symptoms The most widely used form consists of 21 signs and symptoms grouped by system The scoring method allows for standardization of assessment, and consistency of management of infants with NAS Finnegan Scoring Nurses begin the scoring at birth, or whenever symptoms develop Scores are obtained every 2-4 hours, and reflect the entire time period since the previous score A score above 8 denotes neonatal abstinence syndrome requiring nonpharmacologic treatment and possibly treatment with phenobarbital, opiates, or both 15
16 Finnegan Scoring Once an infant is stable on treatment protocol, the scores are used for weaning When scores are consistently <9 for 48 hours, the dose may be decreased by % every 1-2 days Non-Pharmacologic Treatment Quiet environment in private rooms Swaddling Frequent feeds on demand Low lactose formula Holding, rocking, swinging Massage and calming techniques Encourage parents to stay as much as possible Consults Infant Therapy Occupational Therapy Speech Therapy Infant Massage All patients are interviewed by the Staff Social Worker CSB Referrals when indicated Lactation and Nutrition 16
17 Breastfeeding and NAS Acceptable: When the mother is Hepatitis C positive Low dose Methadone treatment Morphine best analgesic for breastfeeding mothers Morphine concentrations in human milk is low and the oral bioavailability is poor Codeine and hydrocodone are regarded as safe when used in low-to-moderate doses Methadone concentrations in human milk are very low, generally not exceeding more than 5% of the maternal dose Not acceptable, if mother has HIV, has active HSV lesions on the breast, untreated active TB, or is an active drug abuser. Pharmacologic Treatment Any infant who has serious symptoms of withdrawal, or two Finnegan scores >8 is given a loading dose of phenobarbital 16 mg/kg (We use the tablet form) This is followed by phenobarbital 2.5 mg/kg/dose BID Pharmacologic Treatment, continued. Infants who have serious NAS at the outset or who are not controlled on Pb alone are given morphine Starting dose for morphine is mg/kg/dose every 3 hours. This may be increased as needed to a maximum of 1.6 mg/kg/day (0.2 mg/kg/dose) 17
18 Adjunct Therapy Clonidine: added to regimen if phenobarbital and morphine do not control symptoms Dose: 0.1 mcg/kg q 4-6 hours Clonidine is well studied and used in adult addicts, and has been shown to be effective in newborns as well - A. Agthe, Pediatrics. May 2009 Infants with NAS ACH Mahoning Valley : : : : : : : Infants with NAS ACH Mahoning Valley NAS Infants
19 Maternal Race 6% N= 207 Caucasian African American 94% Marital Status N= 207 2% 11% Single Married Separated 87% Maternal Employment N= 207 9% Unemployed Employed 91% 19
20 Prenatal Care N= 207 8% 13% NPC Late Adequate 79% Maternal Smoking N= % Tobacco No Tobacco 78% Size for Dates N= % AGA SGA/IUGR 85% 20
21 Treatment of Infants with NAS N= % 14% Pb Only No Rx Opiates 75% Length of Treatment for NAS Akron Children s Mahoning Valley Shortest treatment time: 1 day Longest treatment time: 81 days Average length of treatment: 22.6 days Treatment for NAS First 10 months 2014 All GA 37 weeks + < 37 weeks Total exposed NAS Phenobarbital only Length of Rx days LOS days
22 Promising New Therapies Methadone vs. Buprenorphine Study in NEJM published in December 2010 Compared NAS after maternal methadone or buprenorphine 175 pregnant women were treated with either methadone or buprenorphine in a blinded, randomized trial Treatment was discontinued by 16 of 89 in methadone group (18 %) Treatment was stopped by 28 of 86 women in buprenorphine group (33%) Jones,H. et al. NEJM December 9, 2010 Methadone vs. Buprenorphine, cont. 131 newborns were studied (58 exposed to buprenorphine and 73 to methadone) Results: Buprenorphine babies had Significantly less total morphine Significantly shorter treatment time Significantly shorter LOS Jones,H. et al. NEJM December 9,
23 Methadone vs. Buprenorphine Jones et al, NEJM Dec. 9, 2010 Methadone vs. Buprenorphine Jones, et. al, NEJM Dec. 9, 2010 Sublingual Buprenorphine Study in 2008: compared morphine to sublingual buprenorphine for NAS Buprenorphine group had shorter length of treatment 22 days versus 32 days for morphine Starting dose of buprenorphine was 13.2 mcg/kg/day; increased to max of 39 mcg/kg/day Kraft WK et al. Pediatrics
24 Sublingual Buprenorphine, continued. Follow-up study on treatment of NAS 3 years later A revised dose schema Buprenorphine: 15.9 mcg/kg/day in 3 doses Maximum dose of 60 mcg/kg/day Morphine: 0.4 mg/kg/day up to 1 mg/kg/day Phenobarbital was used only if symptoms were not controlled with opiates Kraft WK et al. Addiction, March 2011 Buprenorphine Study, cont. Buprenorphine and Breast Milk Recent study looked at 7 women on buprenorphine treatment during lactation Maternal dose: 2.4 to 24 mg/day (Mean of 7) Levels of buprenorphine and norbuprenorphine were < 1 % of maternal weight-adjusted dose Levels were not enough to cause any adverse effects Levels were also not sufficient to prevent withdrawal Ilett, et al. Breastfeeding Medicine, August
25 NAS In Summary Neonatal Abstinence Syndrome has become a significant problem around the world Our own population has seen a huge increase in the numbers of affected newborns Maternal substance patterns change with the availability of drugs on the market or on the street New and promising treatments for both mother and infant are within reach Our goal: minimize maternal addiction when possible NAS in Summary, continued The goal for our infants: Shorten their length of stay Maintain them in a comfortable, relatively symptom- free environment while under treatment Encourage maternal-infant bonding when possible and appropriate Continue our search for novel ways to treat infants with NAS (minimize their time on opiates) How You Can Help Routinely work to identify mothers with risk factors for substance use Refer substance abusing mothers for counseling and or treatment programs Screen all mothers with a urine drug screen during pregnancy Recognize infants at high risk for Neonatal Abstinence Syndrome and refer when needed for treatment 25
26 Questions? 26
NEONATAL ABSTINENCE SYNDROME. Osama Naga, M.D. PGY2
NEONATAL ABSTINENCE SYNDROME Osama Naga, M.D. PGY2 Objective: Describe the common causes of NAS Clinical Presentation Diagnosis Identify the different scoring system for pharmacologic therapy Minimize
More informationIdentifying Neonatal Abstinence Syndrome (NAS) and Treatment Guidelines University of Iowa Children s Hospital -2/11/13
Identifying Neonatal Abstinence Syndrome (NAS) and Treatment Guidelines University of Iowa Children s Hospital -// What is Neonatal Abstinence Syndrome? Neonatal withdrawal after intrauterine exposure
More informationCurrent Trends In Identifying And Treating Newborns With Withdrawal Syndromes 6/24/2010
Current Trends In Identifying And Treating Newborns With Withdrawal Syndromes 6/24/2010 Substance Exposed Newborns Alcohol Tobacco Caffeine Amphetamines Cocaine Barbituates Selective Serotonin Re-uptake
More informationSubstance Use Guideline 4B PERINATAL OPIOID EXPOSURE, CARE OF THE NEWBORN
British Columbia Reproductive Care Program Substance Use Guideline 4B PERINATAL OPIOID EXPOSURE, CARE OF THE NEWBORN INTRODUCTION During the antenatal period, the opportunity exists for the primary care
More informationNEONATAL ABSTINENCE SYNDROME AND SCORING SYSTEM
VIDANT MEDICAL CENTER PATIENT CARE _ SUBJECT: Abstinence Scoring NUMBER: A-1 PAGE: 1 OF: 5 _ NEONATAL ABSTINENCE SYNDROME AND SCORING SYSTEM POLICY: A thorough evaluation of the infant is required in order
More informationCHILDREN S SERVICES. Neonatal Abstinence Syndrome
CHILDREN S SERVICES Neonatal Abstinence Syndrome Background Neonatal Abstinence Syndrome (NAS) is a combination of behavioural and physiological signs and symptoms that occur in newborns going through
More informationNeonatal Abstinence Syndrome: Indian Health Service (IHS) Best Practices Guidelines
Neonatal Abstinence Syndrome: Indian Health Service (IHS) Best Practices Guidelines 1. Neonatal Drug Withdrawal Intrauterine exposure to certain drugs and medications can cause clinical symptoms in the
More informationTreatment Guidelines for Neonatal Narcotic Abstinence Syndrome with Diluted Oral Morphine and Clonidine
Treatment Guidelines for Neonatal Narcotic Abstinence Syndrome with Diluted Oral Morphine and Clonidine Background Morphine sulfate has been recommended by the AAP as the first-line agent for the pharmacologic
More information(peak at 2 days 6 wks)
Perinatal Manual of Southwestern Ontario A collaboration between the Regional Perinatal Outreach Program of Southwestern Ontario & the Southwestern Ontario Perinatal Partnership (SWOPP) Chapter 46 NEONATAL
More informationManagement of Neonatal Abstinence Syndrome and Iatrogenic Drug Withdrawal
Management of Neonatal Abstinence Syndrome and Iatrogenic Drug Withdrawal Kirsten H. Ohler, Pharm.D., BCPS Clinical Assistant Professor Neonatal / Pediatric Clinical Pharmacist University of Illinois at
More informationIntroduction to Neonatal Abstinence Syndrome
Introduction to Neonatal Abstinence Syndrome Cara Christ, MD Director, Arizona Department of Health Services Learning Objectives 1.Define Neonatal Abstinence Syndrome 2.Describe Neonatal Abstinence Syndrome
More informationSubstance Abuse During Pregnancy: Moms on Meds. Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates
Substance Abuse During Pregnancy: Moms on Meds Jennifer Anderson Maddron, M.D LeConte Womens Healthcare Associates 2010 National Survey on Drug Use and Health An estimated 4.4% of pregnant women reported
More informationSubstance Abuse lifestyle Concern for mother - fetus - and - neonate
OBJECTIVES Learn about types of opioids and associated withdrawal symptoms Learn what medications are available to treat opioid addiction Understand the pros and cons associated with each medication Understand
More informationWhat is Methadone? Opioid Treatment Programs Today. Is Methadone Safe? Pain Clinics. Wisconsin OTPs. Methadone Maintenance Treatment 5/6/2013
Methadone Maintenance Treatment Tanya Hiser, MS, LPC State Opioid Treatment Authority April 22, 2013 What is Methadone? Schedule II pharmaceutical opioid similar to Oxycodone or morphine. Binds to the
More informationNNEPQIN Guideline for the Management of Labor, Delivery and the Newborn in the Opioid Dependent Pregnancy. March 2014
The following guidelines are intended only as a general educational resource for hospitals and clinicians, and are not intended to reflect or establish a standard of care or to replace individual clinician
More informationManagement of Pregnancy. Opioid Addiction Treatment
Management of Pregnancy Opioid Addiction Treatment Perinatal Opioid Addiction Pharmacotherapy and co-ordination of care are essential elements in the comprehensive care of pregnant patients with opioid
More informationFrom the street to the NICU. Richard Christensen, PA, CAS
From the street to the NICU Richard Christensen, PA, CAS Treatment works Truths Disconnect with pregnant women seeking treatment Disconnect between community and science Medication is not a stand-alone
More informationMethadone and Pregnancy
Methadone and Pregnancy Methadone 101/Hospitalist Workshop Launette Rieb, MD, MSc, CCFP, CCSAM, FCFP Clinical Associate Professor, Dept. Family Practice, UBC American Board of Addiction Medicine Certified
More information4/28/2014. Care of the Opiate Exposed Newborn and Family Marybeth Tyler, NNP-BC, MS, IBCLC May, 2014. The reality: Poly drug exposure
Practice Gap: Need for increased education regarding management of Neonatal Abstinence Syndrome Desired Outcome: Increased awareness and understanding of NAS Care of the Opiate Exposed Newborn and Family
More informationOpioid/Opiate Dependent Pregnant Women
Opioid/Opiate Dependent Pregnant Women The epidemic, safety, stigma, and how to help. Presented by Lisa Ramirez MA,LCDC & Kerby Stewart MD The prescription painkiller epidemic is killing more women than
More informationMagee-Womens Hospital
Magee-Womens Hospital Magee Pregnancy Recovery Program: History Pregnancy Recovery Center A Medical Home Model Approach to Strengthen Families Bawn Maguire, MSN, RN Programmatic Nurse Specialist Stephanie
More information10/18/2012. The Impact of Substance Use on Newborns. Objectives. Do Infants Exposed to Maternal Opioids Have Drug Addiction?
Objectives The Impact of Substance Use on Newborns Pamela Harris-Haman, CRNP, NNP-BC 1. Discuss the incidence of drug use in pregnancy and the percentage of infants that have abstinence syndrome. 2. Review
More informationIdentifying and Managing Substance Use During Pregnancy
Identifying and Managing Substance Use During Pregnancy Joseph B. Landwehr, Jr., MD Director, Perinatal Center IU Health Ball Memorial Hospital OBJECTIVES Overview of illicit drug use in pregnant women
More informationEstablished in 1974 Non-Profit Federal Block Grant recipient Accept Medicaid, Private Insurance, and Self-Pay.
Established in 1974 Non-Profit Federal Block Grant recipient Accept Medicaid, Private Insurance, and Self-Pay. Patients are not denied treatment if they do not have the ability to pay for services Schedule
More informationBABIES BORN TO ADDICTED MOTHERS
BABIES BORN TO ADDICTED MOTHERS PATRICA M. MESSERLE LICENSED CLINICAL PSYCHOLOGIST, M.A., ABSNP LICENSED SCHOOL PSYCHOLOGIST DIPLOMATE OF THE AMERICAN BOARD OF SCHOOL- NEUROPSYCHOLOGY 1 Signs and Symptoms
More informationNeonatal Abstinence Syndrome. A Guide for Families
Neonatal Abstinence Syndrome A Guide for Families Contents What is Neonatal Abstinence Syndrome (NAS)?...................... 4 When will my baby show signs of NAS?..................................................
More informationSOUTH CENTRAL NEONATAL NETWORK GUIDELINE. South Central (North) Guideline for Neonatal Drug Withdrawal
SOUTH CENTRAL NEONATAL NETWORK GUIDELINE South Central (North) Guideline for Neonatal Drug Withdrawal Approved by & South Central Neonatal Steering Group for South Central North. date Date of Implementation
More informationNeonatal Drug Withdrawal. John Wareham, MD Department of Neonatology, St. Vincent Women s Hospital
Neonatal Drug Withdrawal John Wareham, MD Department of Neonatology, St. Vincent Women s Hospital Neonatal Drug Withdrawal What are we going to cover? Overview of the problem in neonates Opioid exposure/dependence
More informationMassachusetts Department of Public Health Guidelines for Community Standard for Maternal/Newborn Screening For Alcohol/Substance Use
The Commonwealth of Massachusetts Executive Office of Health and Human Services Department of Public Health 250 Washington Street, Boston, MA 02108-4619 DEVAL L. PATRICK GOVERNOR TIMOTHY P. MURRAY LIEUTENANT
More informationV11.2 NPIC/QAS. Special Quarterly Report: Linked Analysis Neonatal Abstinence Syndrome
V11.2 NPIC/QAS Special Quarterly Report: Linked Analysis Neonatal Abstinence Syndrome I. Background The use of drugs and alcohol during pregnancy has been shown in several studies to affect the health
More informationWelcome. How Do I Ask Questions? Agenda. Thank you for joining us today. The webinar will begin in a few moments.
Welcome How Do I Ask Questions? Thank you for joining us today. The webinar will begin in a few moments. If you are experiencing technical problems with the GoToWebinar program, contact the GoToWebinar
More information2013 Transforming Neonatal Drug Withdrawal
2013 Transforming Neonatal Drug Withdrawal Carl R. Backes, DO Director, Neonatal Abstinence Clinic Nationwide Children s Hospital Clinical Assistant Professor, The Ohio State University How Big is the
More informationPresentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas
Presentation to Senate Health and Human Services Committee: Prescription Drug Abuse in Texas David Lakey, MD Commissioner, Department of State Health Services Lauren Lacefield Lewis Assistant Commissioner,
More informationDisclosure. Objectives. ~History~ 5/11/2015. ~History~
Disclosure Dr. Reilly has disclosed no relevant financial relationships with any commercial interests. 2015 Annual WAPC Conference Maureen Reilly DNP, NNP-BC bjectives At the conclusion of the session,
More informationChildren s Specialized Hospital Neonatal Abstinence Syndrome (NAS)
Children s Specialized Hospital Neonatal Abstinence Syndrome (NAS) A Pharmacologic and Rehabilitation Program that Promotes Narcotic Weaning and Autonomic Regulation Necessary for Infant Development Sharon
More informationWales Neonatal Network Guideline
Guideline on the Management of Neonatal Abstinence Syndrome Introduction Neonatal Abstinence Syndrome (NAS) is a constellation of symptoms and signs occurring in a baby as a result of withdrawal from physically
More informationChallenges of Foster Parents who Care for Infants with Neonatal Abstinence Syndrome
Challenges of Foster Parents who Care for Infants with Neonatal Abstinence Syndrome All Health Care Providers are required by law to make a referral to the Department of Children s Services (DCS) Child
More informationNEONATAL ABSTINENCE SYNDROME (NAS)- THE CARE YOUR BABY MAY NEED
NEONATAL ABSTINENCE SYNDROME (NAS)- THE CARE YOUR BABY MAY NEED Information Leaflet Your Health. Our Priority. Page 2 of 8 Welcome to Stepping Hill Hospital Women's Unit The aims of this leaflet are to:
More informationAddressing Substance Use in Pregnancy
Addressing Substance Use in Pregnancy Stefan Maxwell, MD Director, NICU, CAMC Women and Children s Hospital Chair, Drug Use in Pregnancy Committee West Virginia Perinatal Partnership July 31, 2013 WV Early
More informationIncidence. Substance Abuse. Care of the Drug Exposed Infant. 2010 National Survey on Drug Use and Health:
Care of the Drug Exposed Infant Connie Anderson M.D. Assistant Professor of Pediatrics Saint Louis University School of Medicine Cardinal Glennon Children s Medical Center September 19,2012 Substance Abuse
More information3/31/2015. Objectives. Alcohol. Long term effects. Substance abuse increases the risk of: Substance Abuse in Pregnancy
Objectives Substance Abuse in Pregnancy Basics of screening and counseling Minako Watabe, MD Obstetrics and Gynecology Ventura County Medical Center 1) Discuss the risks of alcohol, tobacco, and drug use
More information4/13/15. Case 1. COWS = Clinical Opioid Withdrawal Scale. Special Populations
Special Populations ACMT Addiction Academy Faculty Panelists 1 Case 1 The Toxicology service is consulted from the ED as the county jail has brought in a 21 year-old Hispanic woman who is 18 weeks pregnant.
More informationNew York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery
New York State Office of Alcoholism & Substance Abuse Services Addiction Services for Prevention, Treatment, Recovery USING THE 48 HOUR OBSERVATION BED USING THE 48 HOUR OBSERVATION BED Detoxification
More informationNeonatal Abstinence Syndrome (NAS)
Women and Newborn Health Service King Edward Memorial Hospital Neonatal Abstinence Syndrome (NAS) W O M E N A N D N E W B O R N drug and alcohol service (wandas) Delivering a Healthy WA Neonatal Abstinence
More information10/19/15. Stephen Loyd, M.D., F.A.C.P Healthy Kingsport Meadowview Convention Center Kingsport, Tennessee October 17, 2015
Stephen Loyd, M.D., F.A.C.P Healthy Kingsport Meadowview Convention Center Kingsport, Tennessee October 17, 2015 Receives no commercial support, in any form, from pharmaceutical companies or anyone else
More informationNeonatal Abstinence Syndrome Anthony E. Burgos and Bryan L. Burke, Jr. DOI: 10.1542/neo.10-5-e222
Neonatal Abstinence Syndrome Anthony E. Burgos and Bryan L. Burke, Jr NeoReviews 2009;10;e222-e229 DOI: 10.1542/neo.10-5-e222 The online version of this article, along with updated information and services,
More informationNeonatal Abstinence Syndrome: An Emerging Epidemic?
Neonatal Abstinence Syndrome: An Emerging Epidemic? March 11, 2013 Balaji Govindaswami, MD, MPH Chief Newborn Medicine, Director - NICU Santa Clara Valley Health and Hospital System, San Jose, CA Clinical
More informationOpiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio
Governor s Cabinet Opiate Action Team Promoting Wellness and Recovery John R. Kasich, Governor Tracy J. Plouck, Director Opiate Addiction in Ohio: An Update on Scope of Problem Ashland Ohio November 14,
More informationHeroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?
Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown
More informationOPIOIDS. Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School
OPIOIDS Petros Levounis, MD, MA Chair Department of Psychiatry Rutgers New Jersey Medical School Rutgers New Jersey Medical School Fundamentals of Addiction Medicine Summer Series Newark, NJ July 24, 2013
More informationCollaborative Care for Pregnant Women with Substance Use Disorders
Collaborative Care for Pregnant Women with Substance Use Disorders Alane O Connor DNP Maine Dartmouth Family Medicine Residency MaineGeneral Medical Center Dartmouth Medical School Vanderbilt University
More informationHeroin. How Is Heroin Abused? How Does Heroin Affect the Brain? What Other Adverse Effects Does Heroin Have on Health?
Heroin Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown
More informationDrug Utilization Is On The Rise
Objectives Identify the clinical issues related to opioid prescribing for chronic pain indications Define the clinical needs and expectations of urine drug testing in pain management Address preanalytical
More informationDrug Testing to Support Pain Management
NATIONAL REFERENCE LABORATORY Drug Testing to Support Pain Management 500 Chipeta Way, Salt Lake City, UT 84108 (800) 522-2787 (801) 583-2787 www.aruplab.com www.arupconsult.com ARUP is an enterprise of
More informationPregnant Women with Opioid Addiction. Velma V. Taormina MD MSE FACOG Gaston County DHHS Medical Director March 11, 2016
Pregnant Women with Opioid Addiction Velma V. Taormina MD MSE FACOG Gaston County DHHS Medical Director March 11, 2016 The Vision 2012--Christi Bartell, MD noticed an increased number of newborns showing
More informationNeonatal Abstinence Syndrome
Neonatal Abstinence Syndrome D COGHLAN, *M MILNER, T CLARKE, I LAMBERT, C MCDERMOT, M MCNALLY, M BECKETT. T MATTHEWS Department of Paediatrics and *Obstetrics. Rotunda Hospital. Parnell Square. Dublin
More informationMEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION
MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Mark Fisher Program Administrator State Opioid Treatment Adminstrator Kentucky Division of Behavioral Health OBJECTIVES Learn about types of opioids and
More informationThis is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics
This is the written version of our Hot Topic video presentation available at: MayoMedicalLaboratories.com/hot-topics Welcome to Mayo Medical Laboratories Hot Topics. These presentations provide short discussion
More informationAppropriate Use of UDT to Improve Patient Care
Published on OpioidRisk (http://www.opioidrisk.com) Home > Urine Drug Testing Urine Drug Testing This guide provides: Download Entire Guide [1] Appropriate use of Urine Drug Testing (UDT) to improve patient
More informationHeroin. How is Heroin Abused? What Other Adverse Effects Does Heroin Have on Health? How Does Heroin Affect the Brain?
Heroin Heroin is a synthetic opiate drug that is highly addictive. It is made from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears
More informationLike cocaine, heroin is a drug that is illegal in some areas of the world. Heroin is highly addictive.
Heroin Introduction Heroin is a powerful drug that affects the brain. People who use it can form a strong addiction. Addiction is when a drug user can t stop taking a drug, even when he or she wants to.
More informationEvaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients
Evaluation of a Morphine Weaning Protocol in Pediatric Intensive Care Patients Jennifer Kuhns, Pharm.D. Pharmacy Practice Resident Children s Hospital of Michigan **The speaker has no actual or potential
More informationSubstitution Therapy for Opioid Dependence The Role of Suboxone. Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015
Substitution Therapy for Opioid Dependence The Role of Suboxone Mandy Manak, MD, ABAM, CCSAM Methadone 101-Hospitalist Workshop, October 3, 2015 Objectives Recognize the options available in treating opioid
More informationInteragency Guideline on Opioid Dosing for Chronic Non-cancer Pain (CNCP)
Appendix D: Urine Drug Testing for Monitoring Opioid Therapy i. Monitoring opioid therapy with urine drug testing (UDT) ii. UDT algorithm for monitoring opioid therapy iii. UDT clinical vignettes iv. Frequently
More informationTalk to a Councelor Today. (877) 605-3107 TABLE OF CONTENT 2 HOW TO TREAT HEROIN ADDICTION
TABLE OF CONTENT 4 5 7 8 9 11 12 13 2 HOW TO TREAT HEROIN ADDICTION Almost 1 million Americans (about 966,000 people) struggle with heroin dependency, according to statistics from the National Institute
More informationCare Management Council submission date: August 2013. Contact Information
Clinical Practice Approval Form Clinical Practice Title: Acute use of Buprenorphine for the Treatment of Opioid Dependence and Detoxification Type of Review: New Clinical Practice Revisions of Existing
More informationMEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION
MEDICATION ASSISTED TREATMENT FOR OPIOID ADDICTION Sidarth Wakhlu,M.D. Addiction Team Leader North Texas VA Health Care System Addiction Psychiatry Fellowship Director Associate Professor Of Psychiatry
More informationMedication Assisted Treatment
Medication Assisted Treatment Tanya Hiser, MS, LPC State Opioid Treatment Authority Bureau Of Prevention, Treatment, & Recovery State of Wisconsin Elizabeth Collier, MSW, CSAC, ICS, LCSW TANF Best Practice
More informationOpiates Heroin/Prescription Steve Hanson Opiates Dates to 4,000 BC Mimics endorphin activity Natural - Opium, morphine, codeine Semi-synthetic- Heroin, Dilaudid Synthetics - Darvon, Demerol, Fentanyl Modern
More informationSubstance-Exposed Newborns
Substance-Exposed Newborns State of Oklahoma 2013 Substance-Exposed Newborns State of Oklahoma 2013 Legal Background Federal guidelines in the Child Abuse Prevention and Treatment Act (CAPTA) require states
More informationKarol Kaltenbach, PhD Maternal Addiction Treatment Education and. Jefferson Medical College Thomas Jefferson University
Benzodiazepines and the Pregnant Patient: Special Challenges Karol Kaltenbach, PhD Maternal Addiction Treatment Education and Research Jefferson Medical College Thomas Jefferson University Outline Introduction
More informationEthical Issues Related to Long-Term Consequences of Neonatal Abstinence Syndrome (NAS) Christopher Church, Ph.D.
Ethical Issues Related to Long-Term Consequences of Neonatal Abstinence Syndrome (NAS) Christopher Church, Ph.D. Content and Objectives Content: Describe common ethical issues related to caring for babies
More informationOpioid Addiction & Methadone Maintenance Treatment. What is Methadone? What is an Opioid?
Opioid Addiction & Methadone Maintenance Treatment Dr. Nick Wong MD, CCFP AADAC Edmonton ODP AADAC AHMB Concurrent Disorder Series September 13, 2007 1 What is Methadone? What is methadone? Synthetic opioid.
More informationMANAGEMENT OF THE INFANT BORN TO THE DRUG-ABUSING MOTHER Version: 5 Ratification Date: Feb 2014 Review Date: Feb 2017 Approval:
Title: MANAGEMENT OF THE INFANT BORN TO THE DRUG-ABUSING MOTHER Version: 5 Ratification Date: Feb 2014 Review Date: Feb 2017 Approval: Nottingham Neonatal Service Clinical Guideline Meeting Author: Sara
More informationObjectives. What is NAS? What is NAS? Faculty Disclosure. Providing Optimal Care for Neonates with Neonatal Abstinence Syndrome
Providing Optimal Care for Neonates with Neonatal Abstinence Syndrome by Karen D Apolito, Ph.D., APRN, NNP-BC, FAAN Professor & Program Director, NNP Specialty Vanderbilt University School of Nursing This
More informationToxicology CPT Code Changes for 2016
Beginning January 1, 2016, CMS deleted all 2015 drug testing G codes and will continue to not recognize the AMA CPT codes for drug testing. CMS created three G codes for presumptive testing and four G
More informationDowners/Depressants (pages 40-50)
Downers/Depressants (pages 40-50) Read pages 49-54, 59-60, and 78-79 of the booklet, Street Drugs. Pages 40-50 of the text. Narcotics: Prescription Origin: Southeast Asia, Southwest Asia, and in the Western
More informationJohn R. Kasich, Governor Orman Hall, Director
John R. Kasich, Governor Orman Hall, Director 2 3 Epidemics of unintentional drug overdoses in Ohio, 1979-2011 1,2,3 1800 1600 1400 1200 1000 800 Prescription drugs are causing a larger overdose epidemic
More informationA guide for parents of babies at risk of Neonatal Abstinence Syndrome Planning care for you and your baby
A guide for parents of babies at risk of Neonatal Abstinence Syndrome Planning care for you and your baby Reading this booklet can help you: learn how certain drugs can affect your baby during pregnancy
More informationInformation Booklet for Mum and Baby
WOMEN AND NEWBORN HEALTH SERVICE King Edward Memorial Hospital Information Booklet for Mum and Baby Women and Newborn Drug and Alcohol Service (WANDAS) Delivering a Healthy WA This booklet is designed
More informationThe ABCs of Medication Assisted Treatment
The ABCs of Medication Assisted Treatment J E F F R E Y Q U A M M E, E X E C U T I V E D I R E C T O R C O N N E C T I C U T C E R T I F I C A T I O N B O A R D The ABCs of Medication Assisted Treatment
More informationMarch of Dimes. FAQ on Drug Use and Pregnancy. November 2006. <http://www.marchofdimes.com/14332_1169.asp>. [accessed February 2010]
March of Dimes. FAQ on Drug Use and Pregnancy. November 2006. . [accessed February 2010] After delivery, babies who were exposed to amphetamines before birth
More informationThis module reviews the following: Opioid addiction and the brain Descriptions and definitions of opioid agonists,
BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module II Opioids 101 Goals for Module II This module reviews the following: Opioid addiction and the brain Descriptions
More informationUnderstanding Medication Assisted Treatment (MAT) for Families Affected by Substance Use Disorders
Understanding Medication Assisted Treatment (MAT) for Families Affected by Substance Use Disorders March 20, 2013 Pamela Petersen- Baston, MPA, CAP, CPP 4 9 4 0 I r v i n e B l v d., S u i t e 2 0 2 I
More informationA HISTORICAL PERSPECTIVE ON HUMAN ABUSE LIABILITY STUDIES. Donald R Jasinski, MD
A HISTORICAL PERSPECTIVE ON HUMAN ABUSE LIABILITY STUDIES Donald R Jasinski, MD Origin of methods Modify morphine molecule Develop a selective analgesic lacking abuse potential Reduce public health and
More informationDRUGS OF ABUSE CLASSIFICATION AND EFFECTS
Drug and Drug use DRUGS OF ABUSE CLASSIFICATION AND EFFECTS A pharmaceutical preparation or a naturally occurring substance used primarily to bring about a change in the existing process or state (physiological,
More informationFDA Presentation: Maternal Perspective on Opioid Medication Assisted Therapy
FDA Presentation: Maternal Perspective on Opioid Medication Assisted Therapy Lorraine A. Milio, M.D. Obstetrical Director Center for Addiction and Pregnancy Assistant Professor Maternal-Fetal Medicine
More informationPregnancy and Addiction: A World View of the Problem, Current Treatments and Future Research
Pregnancy and Addiction: A World View of the Problem, Current Treatments and Future Research Hendree E. Jones Associate Professor, Department of Psychiatry Johns Hopkins University Outline I. World view
More informationManagement of Neonatal Opioid Withdrawal
Management of Neonatal Opioid Withdrawal Neonatal Abstinence Syndrome Overview... 1 Opioid Addiction... 1 Opioids and Pregnancy... 1 GUIDELINES FOR MANAGEMENT OF OPIOID-EXPOSED NEWBORNS... 3 Site of Care
More informationSUBSTANCE ABUSE CONCERNS IN CHILD PROTECTION. Presenters: Melissa Kimball and Amy Kelly
SUBSTANCE ABUSE CONCERNS IN CHILD PROTECTION Presenters: Melissa Kimball and Amy Kelly LET S DISCUSS THE DRUG CATEGORIES What are the categories? Opiates-Heroin, Morphine, Codeine, Opium, etc. Depressants-Alcohol,
More informationTriage, Assessment & Treatment Methadone 101/Hospitalist Workshop
Triage, Assessment & Treatment Methadone 101/Hospitalist Workshop Launette Rieb, MSc, MD, CCFP, FCFP Clinical Associate Professor, Dept. Family Practice UBC American Board of Addiction Medicine Certified
More informationfor Management Guidelines Infants with Neonatal Abstinence Syndrome BACKGROUND DIFFERENTIAL DIAGNOSIS
Management Guidelines for Infants with Neonatal Abstinence Syndrome BACKGROUND Neonatal drug withdrawal can occur when newborn infants are exposed to medications or addictive substances in-utero, or can
More informationWe re glad you are here! Agenda for the Day Breaks Lunch Q&A and note cards Phones
We re glad you are here! Agenda for the Day Breaks Lunch Q&A and note cards Phones Learn about the history of opioid addiction and discuss what is happening today in Kentucky Learn about the disease of
More informationBreastfeeding and Substance Abuse: What do we really know? IHS Best Practice Guidelines
Breastfeeding and Substance Abuse: What do we really know? IHS Best Practice Guidelines Anne Merewood PhD MPH IBCLC Consultant to the Indian Health Service Part 4 of our series Illicit Substance Use around
More informationConsiderations in Medication Assisted Treatment of Opiate Dependence. Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT
Considerations in Medication Assisted Treatment of Opiate Dependence Stephen A. Wyatt, D.O. Dept. of Psychiatry Middlesex Hospital Middletown, CT Disclosures Speaker Panels- None Grant recipient - SAMHSA
More informationRationale for Urine Drug Testing (UDT)
Rationale for Urine Drug Testing (UDT) Help to identify drug misuse/addiction Prior to starting opioid treatment Assist in assessing adherence during opioid therapy As requirement of therapy w/ an opioid
More informationDeveloping Human Fetus
Period Date LAB. DEVELOPMENT OF A HUMAN FETUS After a human egg is fertilized with human sperm, the most amazing changes happen that allow a baby to develop. This amazing process, called development, normally
More informationUpdate on Buprenorphine: Induction and Ongoing Care
Update on Buprenorphine: Induction and Ongoing Care Elizabeth F. Howell, M.D., DFAPA, FASAM Department of Psychiatry, University of Utah School of Medicine North Carolina Addiction Medicine Conference
More informationDonna Dunn, PhD, CNM, FNP OB/GYN Update
Substance Abuse During Pregnancy Donna Dunn, PhD, CNM, FNP OB/GYN Update Maternal Substance Abuse Objectives Define substance abuse Differentiate between types of substances commonly used during pregnancy
More informationTreatment of Opioid Dependence: A Randomized Controlled Trial. Karen L. Sees, DO, Kevin L. Delucchi, PhD, Carmen Masson, PhD, Amy
Category: Heroin Title: Methadone Maintenance vs 180-Day psychosocially Enriched Detoxification for Treatment of Opioid Dependence: A Randomized Controlled Trial Authors: Karen L. Sees, DO, Kevin L. Delucchi,
More information