Jones Hendrée E, Terplan Mishka, Meyer Marjorie
UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (HEJ); Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University (HEJ); Behavioral Health System, Baltimore, MD (MT); Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT (MM).
J Addict Med. 2017 Mar/Apr;11(2):90-92. doi: 10.1097/ADM.0000000000000289.
Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater. Furthermore, while medically assisted withdrawal is being proposed as a public health strategy to reduce neonatal abstinence syndrome (NAS), current data do not support a reduction in NAS with medically assisted withdrawal relative to opioid agonist pharmacotherapy. Overall, the data do not support either benefit of medically assisted withdrawal or equivalence to opioid agonist pharmacotherapy for the maternal-newborn dyad. Medically assisted withdrawal increases the risk of maternal relapse and poor treatment engagement and does not improve newborn health. Treatment of chronic maternal disease, including opioid agonist disorder, should be directed toward optimal long-term outcome.
关于阿片类激动剂药物治疗以及反对药物辅助戒断的建议是基于早期报告，这些报告将戒断与母亲复发和胎儿死亡联系起来。近期病例系列的数据对这些建议提出了质疑。尽管这些数据不支持药物辅助戒断与胎儿死亡之间存在关联，但复发仍然是一个重大的临床问题，报告的复发率在17%至96%之间（平均48%）。鉴于这些研究中的随访失访率很高，实际复发率可能更高。此外，虽然药物辅助戒断被提议作为一种公共卫生策略来减少新生儿戒断综合征（NAS），但目前的数据不支持相对于阿片类激动剂药物治疗，药物辅助戒断能降低NAS的发生率。总体而言，数据不支持药物辅助戒断对母婴二元组有任何益处或等同于阿片类激动剂药物治疗。药物辅助戒断会增加母亲复发和治疗依从性差的风险，并且不会改善新生儿健康。对慢性母亲疾病，包括阿片类激动剂障碍的治疗，应朝着最佳的长期结果进行。
