Post-graduate Medical Education, University of Toronto, Toronto, ON, Canada (SG), St. Michael's Hospital, Department of Pediatrics, Toronto, ON, Canada (DMC, MS), Department of Pediatrics, University of Toronto, Toronto, ON, Canada (DMC, MS), Department of Mental Health and Addictions, St. Michael's Hospital, Toronto, ON, Canada (SG, AC, TG, WL, ST), Department of Psychiatry, University of Toronto, Toronto, ON, Canada (AC, TG, WL), Department of Family and Community Medicine, St Michael's Hospital, Toronto, ON, Canada (SG, EL, MN, ST), Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada (EL, MN, ST), Department of Family Medicine, McMaster University, Hamilton, ON, Canada (ST).
J Addict Med. 2021;15(5):435-438. doi: 10.1097/ADM.0000000000000776.
In the era of highly potent illicit opioids, such as fentanyl and carfentanil, injectable opioid agonist treatment (iOAT) is an effective treatment for those with severe and treatment-refractory opioid use disorder. Untreated opioid use disorder in pregnancy can lead to maternal and neonatal morbidity and mortality. There are currently limited reports on the use of iOAT in pregnant women. The in-patient setting may provide an opportunity to pregnant women for stabilization with iOAT where first line therapies have been ineffective.
We report a case of a pregnant individual who engaged in daily intravenous fentanyl who was admitted to the hospital at 29 weeks gestation for stabilization with iOAT, methadone, and slow-release oral morphine. Before admission, she endured 6 opioid overdoses in her pregnancy and continued to use illicit intravenous opioids in the community despite high dose methadone combined with slow-release oral morphine. Her withdrawal symptoms and cravings were ameliorated with hydromorphone 90 mg IM/IV BID, methadone 135 mg daily, and morphine sulfate sustained release 600 mg daily. With this regimen, she was able to reduce her intravenous fentanyl use to a single episode during her hospitalization. She completed her pregnancy in hospital, delivering a full-term live infant after receiving comprehensive prenatal care.
This case report highlights iOAT as an option during pregnancy and describes the in-patient setting as appropriate to retain high-risk patients in care. This approach may benefit those who are refractory to standard opioid agonist treatment, the numbers of whom may be rising as tolerance to the illicit supply increases.
在强效非法阿片类药物（如芬太尼和卡芬太尼）流行的时代，注射用阿片类药物激动剂治疗（iOAT）是治疗严重且治疗抵抗性阿片类药物使用障碍的有效方法。未经治疗的妊娠期间阿片类药物使用障碍可导致孕产妇和新生儿发病率和死亡率增加。目前，关于 iOAT 在孕妇中的使用报告有限。住院治疗为孕妇提供了一个机会，使她们在一线治疗无效的情况下可以接受 iOAT 稳定治疗。
我们报告了一例怀孕个体，该个体每天静脉注射芬太尼，在妊娠 29 周时因 iOAT、美沙酮和口服吗啡缓释片稳定治疗而入院。在入院前，她在怀孕期间经历了 6 次阿片类药物过量，并尽管接受了高剂量美沙酮联合口服吗啡缓释片治疗，但仍继续在社区内使用非法静脉内阿片类药物。她的戒断症状和渴望通过 90mg 氢吗啡酮肌内/静脉注射 BID、135mg 美沙酮每日和 600mg 硫酸吗啡缓释片每日得到缓解。通过这种治疗方案，她能够减少住院期间静脉注射芬太尼的使用次数，仅发生 1 次。她在接受全面产前护理后，在医院内完成了妊娠，分娩出一个足月活婴。
本病例报告强调了 iOAT 是妊娠期间的一种选择，并描述了住院治疗是保留高风险患者接受治疗的适当方法。这种方法可能对那些对标准阿片类药物激动剂治疗抵抗的患者有益，随着对非法供应的耐受性增加，这些患者的数量可能会增加。
