Faculty Bibliography

Background/UNASSIGNED:Neonatal abstinence syndrome (NAS) is common, expensive, and hurts opioid addicted women and their families. Current treatments do not sufficiently address comorbid addictions, especially tobacco use, among pregnant buprenorphine-maintained women. Methods/UNASSIGNED:25 consecutive admissions of pregnant, opioid addicted women were treated with buprenorphine maintenance and a novel intervention for pregnant opioid addicted patients, Drug Use Targeted Therapy (DUST). DUST entails a combination of informing women about the impact of various drugs on their fetus, discussing the woman's thinking about these consequences of drug use, and varying the frequency of psychotherapy; increasing if addictive drugs are used and decreasing if the woman wishes when drug use is stopped. Results/UNASSIGNED:20/25 remained in treatment until delivery. All 20 women were using addictive drugs at admission. None were planned pregnancies. There was a high prevalence of emotional, physical or sexual abuse, criminal behavior, comorbid psychiatric disorders, and chronic pain. Nineteen stopped all addictive drugs. NAS was present for 5 out of 19 newborns with a duration of hospitalization from 4 to 6 days. Conclusions/UNASSIGNED:This preliminary open-label case series found that pregnant buprenorphine maintained women can stop tobacco. What has sometimes been termed "neonatal opioid abstinence syndrome" may most accurately be termed, "neonatal opioid/tobacco abstinence syndrome." If the treatment effectively addresses tobacco use, other addictive drugs are rarely used. DUST resulted in a 95% quit rate for addictive drugs. Pilot data on this new intervention is limited; a case series that does not have a corresponding control group.

Like other counties across the nation, Fulton County, GA, has seen a significant increase in the number of arrests of people with serious mental illness. While Fulton County has accountability courts, some defendants with mental illness are not able to take advantage of these options due to their mental illness rendering them incompetent to understand the expectations required by these courts. The WISE (Women's Initiative for Success with Early Intervention) pilot project created a pathway for incompetent women to be diverted out of jail and into mental health treatment that was faster than the traditional evaluation for competency to stand trial pathway. A total of 16 female misdemeanants with non-violent charges were referred to the program. All women in WISE received intensive case management services. Some women were sent to a psychiatric hospital for involuntary hospitalization, some were released back to the community, and some were sent to a state forensic hospital for competency restoration services. Compared with a similar group of female misdemeanants prior to inception of the pilot project, women in the WISE group spent significantly fewer days in jail (mean of 64.9 days versus 163.46 days). Thus, preliminary findings from the pilot project indicate that referral to the WISE program significantly reduced the burden of excess time in jail associated with having an untreated mental illness.

When medical interventions fail, it's often because there is no mutually agreed-upon regimen for the patient to follow. The authors provide evidence-based strategies to improve adherence, plus an easy-to-use prescribing checklist.

INTRODUCTION/BACKGROUND:Because of their circulation through the blood, the multiplicity of receptor sites, and the diversity of functions, opioids may most accurately be designated as a hormone. Opioids modulate the intensity of pain. In mammals, the opioid system has been modified to modulate social interactions as well (Panksepp and Watt, 2011). METHODS:Over 10,000 patient encounters were observed on a neuropsychoanalytic addiction medicine service. Cold pressor times (CPT) were recorded before and after stimulation of the opioid system with low-dose naltrexone (LDN) for patients after opioid detoxification and for fibromyalgia patients. RESULTS:Patients maintained on opioids relate autistically. The cold, unrelated nature of their human interactions was reversed by detoxification from opioids. Fibromyalgia patients have difficulty participating in human relationships, as if they lack an ability to respond interpersonally, as do post-detoxification patients. LDN improved pain tolerance as shown by a significant increase on CPT for post detoxification patients from 16 seconds to 55 seconds and in fibromyalgia patients from 21 seconds to 42 seconds, and improved relatedness. The correlation of opioid prescribing increasing over time and autism prevalence increasing over time is highly significant. CONCLUSIONS:1. Opioid-maintained patients relate autistically. 2. Autism is a hyperopioidergic disorder. 3. Fibromylagia is a hypoopioidergic disorder. 4. Low opioid tone caused by opioid maintenance or fibromyalgia can usually be reversed with low-dose naltrexone. 5. The increase in the incidence of autism may have been caused by the increase in use of opioids for analgesia during childbirth.