Background: The prevalence of opioid use disorder has increased across the United States, but the rural population of Appalachia has been disproportionately impacted. Concurrently, the slow, but steady progress in the legalization of marijuana may be affecting perception of marijuana use in pregnancy. However, marijuana use in pregnancy has been associated with adverse perinatal outcomes. Concomitant use of opioids and marijuana in pregnancy has not been evaluated. Objective: The primary aim of the study was to evaluate the association between confirmed marijuana use in late pregnancy and preterm birth in opioid-exposed pregnancies. Methodology: A retrospective chart review was conducted that included all births from July 2011 to June 2016 from 6 delivery hospitals in South-Central Appalachia. Out of 18,732 births, 2368 singleton pregnancies indicated opioid use and met remaining inclusion criteria, with 108 of these mothers testing positive for marijuana at delivery. Independent sample t-test and Chi-Square analyses compared marijuana and non-marijuana exposed groups on maternal and neonatal outcomes. Regression analyses controlled for confounding variables in predicting neonatal abstinence syndrome (NAS), NICU admission, preterm birth, small for gestational age, and low birth weight outcomes as shown in Table 1. Results: Neonates born to marijuana-positive women in opioid-exposed pregnancy were more likely to be born preterm, small for gestational age, have low birth weight, and be admitted to NICU. After statistically controlling for parity, marital status, tobacco and benzodiazepine use, preterm birth and low birth weight remained statistically significant with aOR of 2.35 (1.30–4.24) and 2.01 (1.18–3.44), respectively. Conclusions: Maternal use of marijuana in any opioid-exposed pregnancy may increase risk of preterm birth and low-birth weight infants. Prospective studies need to examine the dose and timing of marijuana and opioid use in pregnancy to better delineate perinatal effects. Nonetheless, pregnant women using opioids, including recommended medication assisted treatment for opioid use disorder, should be educated about the risks of concurrent marijuana use during pregnancy and may need to be counseled to abstain from marijuana use during pregnancy for an optimal outcome.

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This review will focus on a systems medicine approach to neonatal abstinence syndrome (NAS). Systems medicine utilizes information gained from the application of “omics” technology and bioinformatics (1). The omic approaches we will emphasize include genomics, epigenomics, proteomics, and metabolomics. The goals of systems medicine are to provide clinically relevant and objective insights into disease diagnosis, prognosis, and stratification as well as pharmacological strategies and evidence-based individualized clinical guidance. Despite the increasing incidence of NAS and its societal and economic costs, there has been only a very modest emphasis on utilizing a systems medicine approach, and this has been primarily in the areas of genomics and epigenomics. As detailed below, proteomics and metabolomics hold great promise in advancing our knowledge of NAS and its treatment. Metabolomics, in particular, can provide a quantitative assessment of the exposome, which is a comprehensive picture of both internal and external environmental factors affecting health.

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Neonatal abstinence syndrome (NAS) is a drug withdrawal syndrome exhibited by infants born to mothers with opioid use disorder (OUD). The American College of Obstetricians and Gynecologists and other professional societies endorse opioid agonist pharmacotherapy (MATs) as the optimal treatment for OUD during pregnancy. This study focuses on impact of weaning of MAT drugs on the incidence of NAS and neonatal birth outcomes among babies born to women with opioid exposure. The study population included eighty-six pregnant women with OUD, divided in to weaning and non-weaning groups based on their choice to wean the MATs during pregnancy. Univariate analysis was performed between the clinical and demographic variables of both groups. Multivariate analysis was performed to find the association between outcome variables and predictor variables. All analyses were conducted using SAS version 9.4. The study identified a significant negative correlation (p-value: 0.0099) between weaning from MATs and NAS incidence. The study showed significant correlations of weaning with shorter LOS (p-value: 0.0036) and higher birth weights (p-value: 0.0408). Weaning emerged as a significant predictor for decreasing the incidence of NAS and improving the neonatal outcomes. Logistic regression confirmed weaning as a protective factor (odds ratio: 4.881 CI: 1.3, 18.1). The intricacies of weaning of MATs in the context of OUD during pregnancy present profound health and ethical considerations for both mothers and infants. The investigation into NAS incidence among infants born to women with OUD revealed a significant association with weaning from MATs during pregnancy. The study highlights the potential benefits of weaning, offering insights into optimized neonatal care and efficient healthcare resource utilization.

Opioid use disorder (OUD) impacts 5.6 million people in the US. Buprenorphine (BUP) is a commonly prescribed opioid medication used to treat OUD, including in pregnant women. However, opioid use during pregnancy is associated with poorer infant outcomes including reduced fetal growth, neurodevelopmental deficits, and neonatal opioid withdrawal syndrome (NOWS). Recent clinical data suggests that providing mothers with a lower dose of BUP may result in fewer negative outcomes in infants. Here, a preclinical rodent model of low-dose perinatal BUP exposure was used to study offspring health outcomes in the neonate, juvenile, and adolescent offspring. Dams were given clinically relevant doses of BUP prior to and throughout gestation, and continuing through weaning to mimic human doses and exposure. Although the lowest BUP dose still elicited signs of NOWS in offspring, there were fewer negative effects on overall brain morphology across the early lifespan than that of the higher BUP dose compared to controls.

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Bakgrund: LARO i Sverige är omgärdat av strikta regler. Läkemedlen som används, däribland buprenorfin, intas dagligen övervakat av sjuksköterska de tre första månaderna och vidare till dess att patienten bedöms kunna ta läkemedlet på egen hand. Sedan 2018 finns buprenorfin som depotinjektion veckovis eller månadsvis, vilket innebär en ny omvårdnadssituation. Syfte: Att utforska sjuksköterskans perspektiv på införandet av buprenorfin som depotinjektion i LARO. Metod: Tolv semistrukturerade intervjuer av sjuksköterskor med erfarenhet av depotinjektioner buprenorfin i LARO. Resultat: Införandet av depotinjektioner innebar ett fokusskifte i behandling och omvårdnad med bland annat minskad kontroll och ökad tillit mellan sjuksköterska och patient. Behandlingen med depotinjektioner ansågs kunna öppna för ökad egenmakt för patienterna. LARO-enheternas organisatoriska förutsättningar påverkade hur de tagit sig an den nya behandlingsformen. Kunskap och samsyn efterfrågades. Slutsats: Depotinjektioner buprenorfin kan öppna upp för nya sätt att främja egenmakt i LARO. Det finns ett behov av forskning på området. / Background: Opioid substitution treatment in Sweden is strictly regulated. Medications like Buprenorphine are taken daily supervised by a nurse during the initial three months and thereafter until the patient is assessed to be trusted with self-administration. Prolonged-release injectable Buprenorphine has beenavailable since 2018 for weekly or monthly use. This has implications for nursing care and practices. Purpose: To explore the nurse’s perspective on introducing prolonged-release injectable buprenorphine in opioid substitution treatment. Method: Twelve semi-structured interviews were conducted with nurses experienced in treatment with prolonged-release injectable buprenorphine. Results: The introduction of injection treatment entailed a shift in focus regarding restrains, trust and patient empowerment. The care units’ approaches to the new treatment differed and was influenced by organisational conditions. Nurses requested more knowledge and consensus about the new treatment. Conclusion:Prolonged-release injectable formulations may enable new approaches to patientempowerment in opioid substitution treatment. Research in this field is required.

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