ABSTRACT

Background

Rates of opioid use disorder and opioid overdose during pregnancy and in the postpartum period are increasing. While methadone remains a cornerstone of treatment for women with opioid use disorder during pregnancy, methadone titrations are constrained by guidelines designed for the outpatient setting, where it may take several weeks before doses are therapeutic.

Case Summary

In the current case report, we describe and discuss a rapid inpatient titration of methadone in an acute care setting for a pregnant woman with severe opioid use disorder, not previously on medication for opioid use disorder.

Discussion

Pregnant women with severe opioid use disorder are at high risk of negative maternal and fetal outcomes, necessitating a mechanism for rapid stabilization on evidence-based pharmacotherapy. While current methadone guidelines are designed to minimize overdose risk during the titration period in outpatient settings, we believe this risk can be mitigated in the inpatient setting by utilizing small, split doses and careful observation.

中文翻译：

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病例报告：孕期住院快速滴定美沙酮

摘要

背景

怀孕期间和产后阿片类药物使用障碍和阿片类药物过量的发生率正在增加。虽然美沙酮仍然是治疗妊娠期阿片类药物使用障碍妇女的基石，但美沙酮的滴定受到为门诊环境设计的指南的限制，在这些情况下，剂量可能需要数周才能达到治疗效果。

案例总结

在当前的病例报告中，我们描述并讨论了在急性护理环境中为患有严重阿片类药物使用障碍的孕妇快速住院滴定美沙酮的方法，该孕妇以前未接受过阿片类药物使用障碍的药物治疗。

讨论

患有严重阿片类药物使用障碍的孕妇有很高的母婴不良结局风险，因此需要一种机制来快速稳定循证药物治疗。虽然目前的美沙酮指南旨在最大限度地降低门诊环境中滴定期间用药过量的风险，但我们相信，在住院环境中，可以通过使用小剂量、分次给药和仔细观察来减轻这种风险。