Outline Substance Abuse Screening in Pregnancy
|
|
- Blake Owen
- 8 years ago
- Views:
Transcription
1 Outline Substance Abuse Screening in Pregnancy Allison S. Bryant, MD, MPH Department of Obstetrics, Gynecology & RS University of California, San Francisco Antepartum and Intrapartum Management June 7, 2007 Scope of the Problem Definitions Screening in Pregnancy Individual agents Alcohol Opiates Cocaine Methamphetamines Marijuana Tobacco Substance Abuse: Scope of the Problem 30 million Americans have used illegal substances 40% of year olds 3.6 million Americans have a dependency on illegal substances 9 th leading cause of death in U.S. $4.5B cost in health expenditures $44B cost in lost productivity Substance Abuse: Scope of the Problem 23% of HS seniors report regular marijuana use 10% of HS students have used an illicit substance SA associated with poor health, harmful behaviors, increased risk of STIs, unintended pregnancy Treatment may have efficacy equivalent to other chronic diseases ACOG, 2000 ACOG,
2 Substance Abuse: Scope of the Problem Prevalence (%) of current use among women age years Pregnant Non-pregnant Alcohol Cigarettes Marijuana Cocaine Other illicit drugs National Household Survey on Drug Abuse, Demographics of Substance Abuse Substance abuse in pregnancy related to Age (vs ) Single marital status Less than high school education NOT related to race/ethnicity May be different prevalence of use of particular substances between women of different races Ebrahim el al., Obstet Gynecol 2003 Chasnoff et al. NEJM 1990 Perinatal Substance Exposure Study California 1992: 2/3 of all CA birthing hospitals sampled at random Urine samples taken from all women admitted for delivery (N = 29,494) 6.7% infants exposed to EtOH, 5.2% to any drug Black women more likely to use cocaine; amphetamines more likely among Whites Neighborhood poverty trumped race in models of prediction Finch et al., Soc Sci Med 2001 Substance Use among Women age % Illicit drug use in past month % Binge drinking in past month % Cigarette smoking in past month National Survey of Drug Use and Health Report, 1/2004 2
3 Pregnancy as teachable moment Definitions: Substance Abuse Recurring pattern of use which substantially impairs functioning in one or more important life areas Family Vocation/employment Psychological Legal Social Physical Ebrahim el al., Obstet Gynecol 2003 Washington State Dept. of Health, 2002 Definitions: Substance Dependency Dependent use which is a primary chronic disease with genetic, psychological and environmental factors influencing its development and manifestations Evidenced by a subjective need for a specific substance Definitions: Addiction Complex, progressive behavior pattern with biological, psychological, sociological and behavioral components Pathological involvement in a behavior Subject to compulsion Reduced ability to exert personal control over use Washington State Dept. of Health, 2002 Washington State Dept. of Health,
4 Universal Screening in Pregnancy Provides opportunity to talk with every patient about risks of alcohol, tobacco, prescription and illicit substances Seeks to eliminate bias Increases likelihood of identifying substance abusers and allows for early intervention Takes ~30 seconds for most patients Ethical Rationale for Universal Screening Beneficence: medical diagnosis of addiction requires intervention in same manner as do other chronic diseases; capacity for marked improvement in health status Nonmaleficence: in the absence of screening, other major health risks may (HIV, other STIs) may be missed ACOG Committee Opinion 294, 2004 Ethical Rationale for Universal Screening Justice: if we fail to apply principles of universal screening, women who are less likely to be screened will have higher burden of disability and lower health status Autonomy: climate of trust and respect must be created to foster effective intervention; must also respect autonomy of woman to refuse screening (in)justice In urban teaching hospital, Black and Hispanic race/ethnicity strongly associated (OR 4.1, 5.3) with documentation of use or non-use of illicit substances (Kerker et al., Ethn Dis 2006) In FL, state with mandatory reporting of mothers known to use alcohol or illicit substances in pregnancy, black women 10 times more likely to be reported (p<0.0001), despite similar rates of positive screens in study (Chasnoff et al., NEJM 1990) ACOG Committee Opinion 294,
5 Screening Tools Self-report Respectful, neutral questions Begin with legal substances, then illicit ones Behavioral patterns Sedation Inebriation Euphoria Agitation Disorientation Prescription drug seeking behavior Screening Tools Medical History Frequent hospitalizations Trauma Unusual infections Cirrhosis, hepatitis, pancreatitis Frequent falls, bruises Chronic mental illness Screening Tools Physical Examination Normal as most common finding in users of illicit drugs Dilated/constricted pupils Tremors Track marks Inflamed/eroded nasal mucosa Increased pulse and BP Screening Tools Laboratory testing Lab testing only acceptable as follow-up for positive interview screen; patient consent needed Time frame for presence of metabolites: Marijuana, acute use 3 days Marijuana, chronic use 30 days Cocaine 1-3 days Amphetamines 1-3 days Heroin 1 day Methadone 3 days 5
6 Ask Advise Assess Major Steps to Intervention Pre-contemplation Contemplation Preparation Action Maintenance Relapse Assist Arrange Alcohol Surgeon General and Secretary of HHS recommend complete abstinence from alcohol Safe level of prenatal alcohol consumption not determined Risk of FAS, stillbirth varies in studies No exact dose-response relationship Binge drinking increases risk Older age, high parity, A-A and N-A race increase risk of FAS Alcohol: Screening Traditional screens (e.g. CAGE) developed in male alcoholics T-ACE questions Developed to screen for prenatal use Includes measure of tolerance to inebriating effects of alcohol question which does not trigger psychological denial Sensitivity 69%, Specificity 85%, Positive predictive value 23% T-ACE 1) How many drinks does it take for you to feel high? (Tolerance, if > 2 drinks, 2 points) 2) Do you feel Annoyed by people complaining about your drinking? (1 point) 3) Have you ever felt the need to Cut down on your drinking? (1 point) 4) Have you ever had a drink first thing in the morning (Eye-opener, 1 point) ** Positive score is > 2 points total 6
7 Treatment Positive screen? Assess current and past alcohol consumption Focus on drinking behavior alone can reduce antepartum alcohol consumption (Chang et al., Obstet Gynecol 2005) Women with heavy drinking patterns should be referred for professional treatment Naturally occurring vs. synthetic Intranasal, inhaled, IV, PO, IM, SQ Intense warmth/rush, followed by sedation No simple screening tool Opiates Opiates Signs/symptoms/behavioral cues Drug craving Anorexia, nausea Hypertension, hyperventilation, tachycardia, yawning, sweating, lacrimation, rhinorrhea, restlessness Late initiation or missed prenatal care visits Impaired work/school performance Poor OB history Children with neurodevelopmental or behavioral problems Children involved with child protective agencies Late to Care Prevalence of Perinatal Drug Exposures, According to Duration of Prenatal Care Vega W et al. NEJM 1993;329:
8 Opiates Perinatal effects IUGR Non-reassuring fetal status Low birth weight Perinatal mortality Neonatal withdrawal SIDS Opiates: Treatment Principle: change from short-acting IV to longacting PO form to reduce craving and withdrawal Methadone Synthetic opioid, blocks heroin effects No euphoria, long half-life Decreased associated maternal morbidity Neonatal abstinence syndrome DOL 2-3 up to a week Buprenorphine May be associated with lower risk of neonatal abstinence syndrome Crystal, granular or powder forms Intranasal, inhaled, IV, PO, PV, PR routes Dose-dependent increase in HR & BP Produces arousal, enhanced alertness, sense of self-confidence Chronic use produces irritability, paranoia, decreased libido Cocaine Cocaine Risk of systemic complications Perinatal effects?congenital anomalies Impaired fetal growth Preterm delivery Placental abruption Neonatal effects Coarse tremor, increased tone Increased risk of SIDS Long-term developmental outcome similar to drugfree newborns 8
9 Cocaine: Treatment Principle: help patient resist urge to restart compulsive cocaine use Group vs. individual counseling Cognitive behavioral therapy Methamphetamine Intranasal, inhaled, IV, PO 4% of US population have tried meth at some point in their lives Users currently concentrated in West/ SW Neurotoxic agent: enhances dopamine release, enhancing mood and body movement Methamphetamine Increases wakefulness, physical activity, respiration, heart rate, blood pressure, and temperature Other effects: irritability, anxiety, insomnia, confusion, tremors, convulsions, cardiovascular collapse and death Long-term effects: paranoia, aggressiveness, extreme anorexia, memory loss, hallucinations, delusions, and severe dental problems Perinatal effects: not well studied. Increased risk of SGA 9
10 Methamphetamine: Treatment No specific pharmacologic therapies currently Similar therapeutic approaches to cocaine abuse Cognitive behavioral therapy Causes CNS depression, changes in attention, memory, information processing Onset within mins, lasting 3-5 hrs No clear association with adverse perinatal outcomes Marijuana Most important modifiable risk factor associated with adverse birth outcomes Associated with LBW, SAB, stillbirth, PPROM, abruption, previa, PTD, congenital anomalies, postnatal morbidities Tobacco 10
11 Tobacco Approximately 25% of U.S. women of reproductive age smoke Smoking prevalence during pregnancy 10-22% Self-report = under-report Nondisclosure rates 24-50% high risk among those reporting quitting after conception Why screen for smoking? Prevalence of Perinatal Drug Exposures, According to Self-Reported Tobacco Use during Pregnancy (California, March through October 1992) Vega W et al. N Engl J Med 1993;329: Smoking Cessation Only 20-40% of smokers stop during pregnancy Risk factors for continuation: Less than high school education More than 10 cigarettes per day Partner who smokes Smoking Cessation Women who receive smoking cessation intervention more likely to have improvement in cessation than those with minimal treatment (70% vs. 0-17%) [Lumley et al., Cochrane Review 2004] Only 49% of OBs routine advise and provide follow-up for smoking cessation 11
12 Treatment Ask about smoking status Advise to quit, reviewing impact of smoking and quitting on maternal and fetal well-being Assess willingness to make a quit attempt Assist in quitting attempt Arrange follow-up throughout pregnancy Treatment: Pharmacotherapy Nicotine replacement Class D drug ACOG: use only when other attempts fail, increased chance of smoking cessation > unknown risk of nicotine replacement + possible concomitant smoking Bupropion Class B drug Higher abstinence rates as compared to placebo or nicotine patch Summary Universal screening as ethical course of action in preconception/prenatal care Nonjudgmental screening techniques Pregnancy as a teachable moment Be aware of specific concerns for particular drugs of abuse Become familiar with local resources for treatment 12
The Clinical Content of Preconception Care: Alcohol, Tobacco, and Illicit Drug Exposures
The Clinical Content of Preconception Care: Alcohol, Tobacco, and Illicit Drug Exposures by R. Louise Floyd, DSN, RN; Brian W. Jack, MD; Robert Cefalo, MD, PhD; Hani Atrash, MD, MPH; Jeanne Mahoney, BSN,
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 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 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 informationHow To Treat A Drug Addiction
1 About drugs Drugs are substances that change a person s physical or mental state. The vast majority of drugs are used to treat medical conditions, both physical and mental. Some, however, are used outside
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 informationDrugFacts: Treatment Approaches for Drug Addiction
DrugFacts: Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please
More informationTreatment Approaches for Drug Addiction
Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call 1-800-662-HELP(4357)
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 informationMaternal and Child Health Issue Brief
Maternal and Child Health Issue Brief Substance Abuse among Women of Reproductive Age in Colorado September 14 9 Why is substance abuse an issue among women of reproductive age? Substance abuse poses significant
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 informationTreatment Approaches for Drug Addiction
Treatment Approaches for Drug Addiction NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call the
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 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 informationMethamphetamine. Like heroin, meth is a drug that is illegal in some areas of the world. Meth is a highly addictive drug.
Methamphetamine Introduction Methamphetamine is a very addictive stimulant drug. 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
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 information1. According to recent US national estimates, which of the following substances is associated
1 Chapter 36. Substance-Related, Self-Assessment Questions 1. According to recent US national estimates, which of the following substances is associated with the highest incidence of new drug initiates
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 informationTHE BASICS. Community Based Medically Assisted Alcohol Withdrawal. World Health Organisation 2011. The Issues 5/18/2011. RCGP Conference May 2011
RCGP Conference May 2011 Community Based Medically Assisted Alcohol Withdrawal THE BASICS An option for consideration World Health Organisation 2011 Alcohol is the world s third largest risk factor for
More informationNEONATAL 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 informationTreatment Approaches for Drug Addiction
Treatment Approaches for Drug Addiction [NOTE: This is a fact sheet covering research findings on effective treatment approaches for drug abuse and addiction. If you are seeking treatment, please call
More informationThe CCB Science 2 Service Distance Learning Program
S2S 2055 DETOXIFICATION Module 1 Post-Test 1. A common use of a biochemical marker is. a. to support or refute other information that leads to proper diagnosis b. for forensic purposes c. in detecting
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 informationAlcohol Overuse and Abuse
Alcohol Overuse and Abuse ACLI Medical Section CME Meeting February 23, 2015 Daniel Z. Lieberman, MD Professor and Vice Chair Department of Psychiatry George Washington University Alcohol OVERVIEW Definitions
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 informationPregnancy and Substance Abuse
Pregnancy and Substance Abuse Introduction When you are pregnant, you are not just "eating for two." You also breathe and drink for two, so it is important to carefully consider what you put into your
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 informationSubstance Abuse and the Pregnant Patient
Substance Abuse and the Pregnant Patient Washington C. Hill, MD, FACOG Medical Director, Labor and Delivery Director, Maternal-Fetal Medicine Sarasota Memorial Hospital (941) 917-6260 (800) 892-7088 washington-hill@smh.com
More informationSubstance Use Disorder Overview. Presented By Ecole J. Barrow-Brooks M.Ed & Darlene D. Owens MBA, LBSW, CADC, ADS
Substance Use Disorder Overview Presented By Ecole J. Barrow-Brooks M.Ed & Darlene D. Owens MBA, LBSW, CADC, ADS 1 National Issue There continues to be a large treatment gap in the U.S. In 2013, an estimated
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 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 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 informationManagement of Substance Use in the Pregnancy Medical Home Setting Sara McEwen, MD, MPH Executive Director, Governor s Institute
Management of Substance Use in the Pregnancy Medical Home Setting Sara McEwen, MD, MPH Executive Director, Governor s Institute 1 Webinar Objectives Describe SBIRT approach to manage substance use in pregnancy
More informationUnderstanding Addiction: The Intersection of Biology and Psychology
Understanding Addiction: The Intersection of Biology and Psychology Robert Heimer, Ph.D. Yale University School of Public Health Center for Interdisciplinary Research on AIDS New Haven, CT, USA November
More informationCompassionate Care In Treating Opioid Dependence During Pregnancy
Compassionate Care In Treating Opioid Dependence During Pregnancy Michelle Lofwall, M.D. University of Kentucky College of Medicine Depts. of Behavioral Science and Psychiatry April 26, 2014 1 None Faculty
More informationNEXT STEPS: TREATING TOBACCO AND CREATING HEALTHY MENTAL HEALTH/SUBSTANCE ABUSE TREATMENT FACILITY ENVIRONMENTS PART I
NEXT STEPS: TREATING TOBACCO AND CREATING HEALTHY MENTAL HEALTH/SUBSTANCE ABUSE TREATMENT FACILITY ENVIRONMENTS PART I Stan Martin, MM Program Director CAI, TCTP Dr John R. Hughes February 19, 2014 Housekeeping
More informationThe Impact of Alcohol
Alcohol and Tobacco Smoking cigarettes and drinking alcohol are behaviors that often begin in adolescence. Although tobacco companies are prohibited from advertising, promoting, or marketing their products
More informationCo-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs
Co-Occurring Substance Use and Mental Health Disorders Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Introduction Overview of the evolving field of Co-Occurring Disorders Addiction and
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 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 informationDelivery of Tobacco Dependence Treatment for Tobacco Users with Mental Illness and Substance Use Disorders (MISUD)
Delivery of Tobacco Dependence Treatment for Tobacco Users with Mental Illness and Substance Use Disorders (MISUD) Learning Objectives Upon completion of this module, you should be able to: Describe how
More informationNC Perinatal & Maternal Substance Abuse Initiative
NC Perinatal & Maternal Substance Abuse Initiative NC Division of MH/DD/SAS Community Policy Management Best Practice Team Starleen Scott Robbins, LCSW Illicit drug use among pregnant women in the U.S.
More informationImportant facts to remember
Important facts to remember If you re pregnant or trying to get pregnant, or if you know someone who is, there are several important points to remember: See a healthcare professional regularly. Get plenty
More informationKarla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center
Karla Ramirez, LCSW Director, Outpatient Services Laurel Ridge Treatment Center 1 in 4 Americans will have an alcohol or drug problems at some point in their lives. The number of alcohol abusers and addicts
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 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 informationWhat Health Professionals Know and Do About Alcohol and Other Drug Use During Pregnancy
What Health Professionals Know and Do About Alcohol and Other Drug Use During Pregnancy Trecia Wouldes, PhD Department of Psychological Medicine A Research Report in Collaboration with Executive Summary
More informationPRESCRIPTION DRUG ABUSE prevention
PRESCRIPTION DRUG ABUSE prevention Understanding Drug Addiction Many people do not understand how someone could abuse drugs even when their life seems to be falling apart. It is often assumed that those
More informationUpdate and Review of Medication Assisted Treatments
Update and Review of Medication Assisted Treatments for Opiate and Alcohol Use Disorders Richard N. Whitney, MD Medical Director Addiction Services Shepherd Hill Newark, Ohio Medication Assisted Treatment
More informationSubstance Abuse In Pregnancy THE MANAGEMENT OF SUBSTANCE USING PARTURIENTS. Case Study OBJECTIVES
THE MANAGEMENT OF SUBSTANCE USING PARTURIENTS Michael K. Lindsay, MD, MPH Division Maternal-Fetal Medicine Department of Gynecology and Obstetrics Emory University School of Medicine Substance Abuse In
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 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 informationCo-morbid Mental Illness & Substance Abuse Challenges to Treatment
Co-morbid Mental Illness & Substance Abuse Challenges to Treatment Trecia Wouldes, PhD Department of Psychological Medicine Brown Research Center for the Study of Children at Risk Outline Extent of co-morbidity
More informationIf the only tool you have is a hammer, you tend to see every problem as a nail.
How do we approach addiction? ADDICTION 101 A basic primer on addiction If the only tool you have is a hammer, you tend to see every problem as a nail. (Abraham Maslow) Definition of addiction Alcoholism
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 informationA Strategic Plan for Improving Preconception Health and Health Care: Recommendations from the CDC Select Panel on Preconception Care
1 A Strategic Plan for Improving Preconception Health and Health Care: Recommendations from the CDC Select Panel on Preconception Care Presentation by Kay A. Johnson, MPH, EdM Research Assistant Professor,
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 informationChapter 12: Substance Abusing Pregnant Women, Substance Exposed Children and Their Families
Chapter 12: Substance Abusing Pregnant Women, Substance Exposed Children and Their Families Introduction Substance abuse includes the abuse of alcohol, tobacco and other drugs. Prenatal substance abuse
More informationPowder speed, whiz, velocity - Usually snorted, ingested or injected
Dr Christine Watson Powder speed, whiz, velocity - Usually snorted, ingested or injected -most common -Approximately 10% purity -Generally produced locally Sticky/oily/waxy form Base, paste, point, pure,
More informationHow To Stop A Pregnant Addict From Getting A Jail Sentence For Drug Use
Case: 3:14-cv-00870-jdp Document #: 14-9 Filed: 01/07/15 Page 1 of 6 APPENDIX 8 Case: 3:14-cv-00870-jdp Document #: 14-9 Filed: 01/07/15 Page 2 of 6 AMERICAN MEDICAL ASSOCIATION Pregnant women will be
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 informationSUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011
INTRODUCTION SUPPORTING WOMEN USING OPIATES IN PREGNANCY: A Guideline for Primary Care Providers May, 2011 Prevalence of Opiate Use and Impact on Maternal, Fetal, and Neonatal Health: The prevalence of
More informationAmerican Society of Addiction Medicine
American Society of Addiction Medicine Public Policy Statement on Women, Alcohol and Other Drugs, and Pregnancy Background The American Society of Addiction Medicine (ASAM) is deeply committed to the prevention
More informationST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;03/13;06/14;07/15
ST. CLAIR COUNTY COMMUNITY MENTAL HEALTH Date Issued: 07/09 Date Revised: 09/11;/13;06/14;07/15 WRITTEN BY Jim Johnson Page 1 REVISED BY AUTHORIZED BY Jessica Moeller Debra Johnson I. APPLICATION: THUMB
More informationactivity guidelines (59.3 versus 25.9 percent, respectively) and four times as likely to meet muscle-strengthening
18 HEALTH STATUS HEALTH BEHAVIORS WOMEN S HEALTH USA 13 Adequate Physical Activity* Among Women Aged 18 and Older, by Educational Attainment and Activity Type, 09 11 Source II.1: Centers for Disease Control
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 informationDrug Abuse and Addiction
Drug Abuse and Addiction Introduction A drug is a chemical substance that can change how your body and mind work. People may abuse drugs to get high or change how they feel. Addiction is when a drug user
More informationPrescription Drug Addiction
Prescription Drug Addiction Dr Gilbert Whitton FAChAM Clinical Director Drug & Alcohol Loddon Mallee Murray Medicare Local Deniliquin 14 th May 2014 Prescription Drug Addiction Overview History Benzodiazepines
More informationSmoking Cessation: Treatment Options for Nicotine Addiction
Smoking Cessation: Treatment Options for Nicotine Addiction Hilary Nierenberg, NP, MPH Center for Interventional Vascular Therapy Columbia University Medical Center Disclosure Statement of Financial Interest
More informationMedical marijuana for pain and anxiety: A primer for methadone physicians. Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015
Medical marijuana for pain and anxiety: A primer for methadone physicians Meldon Kahan MD CPSO Methadone Prescribers Conference November 6, 2015 Conflict of interest statement No conflict of interest to
More informationEpidemiology 521. Epidemiology of Maternal and Child Health Problems. Winter / Spring, 2010
Extended MPH Degree Program School of Public Health Department of Epidemiology University of Washington Epidemiology 521 Epidemiology of Maternal and Child Health Problems Winter / Spring, 2010 Instructor:
More informationMeena Abraham, DrPH, MPH Director of Epidemiology Services Baltimore City Health Department
Meena Abraham, DrPH, MPH Director of Epidemiology Services Baltimore City Health Department 271 Neighborhood Statistical Areas 55 Community Statistical Areas 26 Zip Codes Characteristic Baltimore City
More informationAnd, despite the numbers, for many people, the Facts About Drugs are not clear.
According to the National Survey on Drug Use and Health (NSDUH), an estimated 20 million Americans aged 12 or older used an illegal drug in the past 30 days. This estimate represents 8% percent of the
More informationDrug Free Campus Plan
Baptist University of the Américas, San Antonio, Texas, is committed to maintaining a drug free environment, free of the abuse of alcohol, tobacco and other drugs. Baptist University of the Américas is
More informationDRUG AND ALCOHOL ABUSE POLICY
DRUG AND ALCOHOL ABUSE POLICY It is the policy of the College of Biblical Studies that the unlawful use, manufacture, sale, attempted sale, distribution, transfer, purchase, attempted purchase, cultivation,
More informationSubstance abuse and the nurse practitioner role: the client, the care, & the cost. Bonnie A. Franckowiak, DNP, FNP, CARN-AP NPAM / 2014
Substance abuse and the nurse practitioner role: the client, the care, & the cost Bonnie A. Franckowiak, DNP, FNP, CARN-AP NPAM / 2014 Objectives: After completion of this session, the learner will: 1.
More informationThe University of Toledo - Main Campus Policy
The University of Toledo - Main Campus Policy IV-12 3360-30-12 Alcohol and Substance Abuse. (A) Alcohol and drug abuse policy statement The University of Toledo is committed to promoting and maintaining
More informationUseful Internet Resources Examples
G Useful Internet Resources Examples Selected Alcohol and Drug Abuse Websites NIDA Capsules Sample on Methamphetamine Abuse CSAT by Fax: What Makes an Effective Addictions Counselor? Substance Abuse and
More informationAlcohol Screening and Brief Interventions of Women
Alcohol Screening and Brief Interventions of Women Competency #2 Midwest Regional Fetal Alcohol Syndrome Training Center Competency 2: Screening and Brief Interventions This competency addresses preventing
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 informationAlcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice
Dr IM Joubert Alcohol and nicotine are widely abused substances and are often used together One study showed that 15% of patients visiting a primary care practice for any reason had either an at-risk pattern
More informationPregnant Women Entering Substance Abuse Treatment for the First Time: 10 Year Trends
Women Entering Substance Abuse Treatment for the First Time: 10 Year Trends Prepared By: Stephan Arndt, PhD Director 2010 The University of Iowa Iowa Consortium for Substance Abuse Research and Evaluation
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 informationOVERVIEW WHAT IS POLyDRUG USE? Different examples of polydrug use
Petrol, paint and other Polydrug inhalants use 237 11 Polydrug use Overview What is polydrug use? Reasons for polydrug use What are the harms of polydrug use? How to assess a person who uses several drugs
More informationUCLA Screening and Brief Intervention Training
UCLA Screening and Brief Intervention Training For Alcohol Reduction or Cessation Client Centered Care Western Regional Training Center on Fetal Alcohol Spectrum Disorders Materials provided through funding
More informationAddressing Nicotine Dependence in Treatment
Addressing Nicotine Dependence in Treatment The Elephant in the Living Room Loretta Worthington, MA, MSP Director Worthington Consulting Tobacco Use Has Traditionally Been Trivialized Nicotine addiction
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 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 informationCore Competencies for Addiction Medicine, Version 2
Core Competencies for Addiction Medicine, Version 2 Core Competencies, Version 2, was approved by the Directors of the American Board of Addiction Medicine (ABAM) Foundation March 6, 2012 Core Competencies
More informationDartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft***
Dartmouth Medical School Curricular Content in Addiction Medicine for Medical Students (DCAMMS) Keyed to LCME Core Competency Domains ***Draft*** This content, sorted by LCME competencies is intended to
More informationOutline. Drug and Alcohol Counseling 1 Module 1 Basics of Abuse & Addiction
Outline Drug and Alcohol Counseling 1 Module 1 Basics of Abuse & Addiction About Substance Abuse The Cost of Chemical Abuse/Addiction Society's Response The Continuum of Chemical Use Definitions of Terms
More informationhttp://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx
http://nurse practitioners and physician assistants.advanceweb.com/features/articles/alcohol Abuse.aspx Alcohol Abuse By Neva K.Gulsby, PA-C, and Bonnie A. Dadig, EdD, PA-C Posted on: April 18, 2013 Excessive
More informationSubstance Abuse During Pregnancy
Substance Abuse During Pregnancy Time for Policy to Catch up with Research Barry M. Lester, Ph.D. Infant Development Center, Brown Medical School National Conference of State Legislators Audio Conference
More informationMedication-Assisted Addiction Treatment
Medication-Assisted Addiction Treatment Molly Carney, Ph.D., M.B.A. Executive Director Evergreen Treatment Services Seattle, WA What is MAT? MAT is the use of medications, in combination with counseling
More informationDrug Abuse & Alcoholism
Drug Abuse & Alcoholism PRESENTED BY: ROBERT SWOTINSKY M D FOR MEDICAL EXAMINER COURSE 978-337-4479 P SWOTINSKY@COMCAST.NET Drugs, Drinking, and Driving CMV drivers - more fatalities than any other occupation.
More informationPatients are still addicted Buprenorphine is simply a substitute for heroin or
BUPRENORPHINE TREATMENT: A Training For Multidisciplinary Addiction Professionals Module VI: Myths About the Use of Medication in Recovery Patients are still addicted Buprenorphine is simply a substitute
More informationCHARLES & SUE S SCHOOL OF HAIR DESIGN DRUG AND ALCOHOL POLICY DRUG AND ALCOHOL POLICY; SUBSTANCE ABUSE RESOURCES:
CHARLES & SUE S SCHOOL OF HAIR DESIGN DRUG AND ALCOHOL POLICY DRUG AND ALCOHOL POLICY; SUBSTANCE ABUSE RESOURCES: At Charles & Sue s School of Hair Design, the illicit use of drugs and/or alcohol by staff
More informationCONTROLLED SUBSTANCE CONTRACT
CONTROLLED SUBSTANCE CONTRACT The purpose of this contract is to protect my access to controlled substances and to protect our ability to prescribe for you. The long-term use of substances such as opiates
More information9/8/2014 EPIDEMIOLOGY PUBLIC HEALTH INTERVENTIONS FOR NEONATAL ABSTINENCE SYNDROME DISCLOSURE OBJECTIVES. No financial COI to disclose
PUBLIC HEALTH INTERVENTIONS FOR NEONATAL ABSTINENCE SYNDROME DISCLOSURE No financial COI to disclose Eric Reynolds MD MPH OBJECTIVES To discuss the epidemiology and current scope of the Neonatal Abstinence
More informationDrug and Alcohol Abuse Training revised: October 2015
Drug and Alcohol Abuse Training revised: October 2015 FMCSA is considering going to a seven panel and possibly ten panel. Hair testing may also be acceptable. What is a Drug? A substance which
More information