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In Pregnancy, Buprenorphine Use Up, Methadone Use Down

FRIDAY, April 12, 2019 -- From 2009 to 2015, the prevalence of methadone use decreased and buprenorphine use increased among Medicaid-enrolled pregnant women with opioid use disorder, and the 4Ps Plus and Substance Use Risk Profile-Pregnancy (SURP-P) scale are sensitive for identifying illicit drug use, according to two studies published online April 5 in Obstetrics & Gynecology.

Elizabeth E. Krans, M.D., from the Magee-Womens Research Institute in Pittsburgh, and colleagues evaluated 12,587 pregnancies among 10,741 women with opioid use disorder who had a live birth between 2009 and 2015 to examine trends in medication-assisted treatment, opioid pharmacotherapy, and behavioral health counseling. The researchers observed a decrease in the adjusted prevalence of methadone use from 31.6 to 25.2 percent; the adjusted prevalence of buprenorphine use increased from 15.8 to 30.9 percent.

Victoria H. Coleman-Cowger, Ph.D., from the Batelle Memorial Institute in Baltimore, and colleagues compared and assessed the accuracy of three screening tools to identify illicit drug use and prescription drug misuse in pregnant women. A sample of 500 pregnant women were enrolled and administered three index tests -- 4Ps Plus, NIDA Quick Screen-ASSIST (Modified Alcohol, Smoking and Substance Involvement Screening Test), and the SURP-P scale -- and reference tests. The researchers found that the sensitivity and specificity were 90.2 and 29.6 percent, respectively, for the 4Ps Plus; 79.7 and 82.8 percent, respectively, for the NIDA Quick Screen-ASSIST; and 92.4 and 21.8 percent, respectively, for the SURP-P.

"The dissemination of a strong and clear recommendation for a clinically useful prescription and illicit drug screening tool for pregnant women is highly significant, relevant for public health, and will likely increase screening," Coleman-Cowger and colleagues write.

One author from the Krans study disclosed financial ties to the pharmaceutical industry.

Abstract/Full Text (subscription or payment may be required) - Krans
Abstract/Full Text (subscription or payment may be required) - Coleman-Cowger

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Posted: April 2019

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