From the Families in Recovery (FIR) Unit, BC Women's Hospital and Health Centre, Vancouver, BC, Canada (CJP, SG, IJG, NC, KS, VP); Women's Health Research Institute, Vancouver, BC, Canada (CJP, JC, SG, IJG, KU, AA); Department of Family Practice, University of British Columbia, Vancouver, BC, Canada (CJP); University of British Columbia Faculty of Medicine, Vancouver BC, Canada (JC); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (AA); Department of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada (KU).
J Addict Med. 2023;17(4):431-438. doi: 10.1097/ADM.0000000000001152. Epub 2023 Feb 20.
Untreated opioid use disorder (OUD) in pregnancy may lead to adverse outcomes for the individual and fetus. Injectable opioid agonist therapy (iOAT) is the highest intensity treatment for severe refractory OUD currently available; however, research on perinatal administration is limited. We present the first known case series of 13 pregnant or postpartum participants who received intravenous hydromorphone while admitted to the Families in Recovery (FIR) unit, an in-patient perinatal stabilization unit in Canada.
Patients who received iOAT at FIR between 2019 and 2022 were invited to participate. Prospectively enrolled participants completed a self-report sociodemographics and exposures survey. Medical/social backgrounds of participants at admission, iOAT and other opioid agonist therapy administration, and health/social outcomes of mother and infant at discharge were collected on all participants via retrospective maternal and infant medical chart review.
Participants initiated iOAT while pregnant (n = 5) or postpartum (n = 8) and received iOAT for 23 days on average. At discharge, 8 participants underwent planned transition to community with infant in their care and a discharge plan including outpatient prescriptions, housing arrangements, follow-up appointments, and supportive programming. All infants received oral morphine after delivery and were discharged in good health.
This is the first known case series of iOAT administration in the peripartum. The cases illustrate iOAT as an option that can achieve OUD stabilization in perinatal individuals to support patient engagement and retention in care.
未经治疗的孕期阿片类药物使用障碍（OUD）可能会对个体和胎儿产生不良后果。注射用阿片类激动剂治疗（iOAT）是目前针对严重难治性 OUD 的最高强度治疗方法；然而，关于围产期管理的研究有限。我们首次报告了 13 名怀孕或产后参与者在加拿大住院围产期稳定单位“家庭康复（FIR）”接受静脉注射氢吗啡酮的病例系列。
邀请在 2019 年至 2022 年期间在 FIR 接受 iOAT 的患者参加。前瞻性入组的参与者完成了一份自我报告的社会人口统计学和暴露情况调查。通过回顾性母婴病历审查，收集了所有参与者在入院时、接受 iOAT 和其他阿片类激动剂治疗时的医疗/社会背景，以及母婴出院时的健康/社会结局。
参与者在怀孕期间（n=5）或产后（n=8）开始接受 iOAT，平均接受 iOAT 治疗 23 天。出院时，8 名参与者计划在有婴儿的情况下过渡到社区，并有出院计划，包括门诊处方、住房安排、随访预约和支持性计划。所有婴儿在分娩后都接受了口服吗啡，并健康出院。
这是首例已知的围产期 iOAT 管理病例系列。这些病例说明 iOAT 是一种可以在围产期个体中实现 OUD 稳定的选择，以支持患者参与和保持治疗。
