UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.
Subst Abus. 2020;41(2):181-185. doi: 10.1080/08897077.2019.1635970. Epub 2019 Jul 30.
Opioid use greatly increases the risk of overdose death, as well as contracting human immunodeficiency virus (HIV) and hepatitis. Opioid agonist treatment is recommended for pregnant women who are dependent on opioids. However, there is a dearth of studies on the use of opioid agonist treatment in pregnant teenagers. Ms. A, a 15 year-old G1PO in foster care, presented to our tertiary women's hospital requesting opioid agonist treatment for use of pill opioids. She reported nasal inhalation of 5-6 opioid tablets daily, with recent attempts to self-taper using nonprescribed buprenorphine since learning of her pregnancy. Last reported opioid use was >24 hours prior to admission. Urine drug testing was positive only for opioids (negative for buprenorphine and methadone). She did not exhibit significant withdrawal symptoms while hospitalized. The psychiatric treatment team recommended deferring opioid agonist treatment and pursuing outpatient substance use treatment. Unfortunately, Ms. A did not attend outpatient treatment and was lost to follow up. Based upon our experience and review of the studies regarding opioid use disorder (OUD) and perinatal and adolescent opioid use, we recommend that pregnant adolescents with OUD be referred to opioid agonist treatment with buprenorphine or methadone. Studies specifically addressing opioid agonist treatment in pregnant teenagers are needed.
阿片类药物的使用大大增加了过量死亡的风险，也增加了感染人类免疫缺陷病毒（HIV）和肝炎的风险。建议对依赖阿片类药物的孕妇进行阿片类激动剂治疗。然而，关于在怀孕青少年中使用阿片类激动剂治疗的研究很少。
A 女士是一名 15 岁的 G1PO，寄养在我们的三级妇女医院，她要求使用阿片类激动剂治疗，因为她使用了药丸类阿片。她报告说每天鼻吸 5-6 片阿片类药物，最近因为知道自己怀孕了，试图自行减少非处方丁丙诺啡的用量。最后一次报告的阿片类药物使用是在入院前 24 小时以上。尿液药物检测仅呈阿片类药物阳性（丁丙诺啡和美沙酮阴性）。她在住院期间没有表现出明显的戒断症状。精神科治疗小组建议推迟阿片类激动剂治疗，并进行门诊药物使用治疗。不幸的是，A 女士没有参加门诊治疗，也没有后续跟踪。
根据我们的经验和对围产期及青少年阿片类药物使用的 OUD 研究的回顾，我们建议将患有 OUD 的怀孕青少年转介至使用丁丙诺啡或美沙酮的阿片类激动剂治疗。需要专门针对怀孕青少年的阿片类激动剂治疗进行研究。
