%0 Journal Article %J J Subst Abuse Treat %D 2011 %T Risk of drug-related mortality during periods of transition in methadone maintenance treatment: a cohort study %A Cousins, G %A Teljeur, C %A Motterlini, N %A McCowan, Colin %A Dimitrov, B %A Fahey, T %K Adolescent %K Adult %K Cohort Studies %K Databases, Factual %K Female %K Humans %K Lung Diseases %K Male %K Medical Records %K Methadone %K Middle Aged %K Opiate Substitution Treatment %K Opioid-Related Disorders %K Patient Dropouts %K Prescriptions %K Risk %K Time Factors %K Young Adult %X This study aims to identify periods of elevated risk of drug-related mortality during methadone maintenance treatment (MMT) in primary care using a cohort of 3,162 Scottish drug users between January 1993 and February 2004. Deaths occurring during treatment or within 3 days after last methadone prescription expired were considered as cases "on treatment." Fatalities occurring 4 days or more after leaving treatment were cases "off treatment." Sixty-four drug-related deaths were identified. The greatest risk of drug-related death was in the first 2 weeks of treatment (adjusted hazard ratio 2.60, 95% confidence interval 1.03-6.56). Risk of drug-related death was lower after the first 30 days following treatment cessation, relative to the first 30 days off treatment. History of psychiatric admission was associated with increased risk of drug-related death in treatment. Increasing numbers of treatment episodes and urine testing were protective. History of psychiatric admission, increasing numbers of urine tests, and coprescriptions of benzodiazepines increased the risk of mortality out of treatment. The risk of drug-related mortality in MMT is elevated during periods of treatment transition, specifically treatment initiation and the first 30 days following treatment dropout or discharge. %B J Subst Abuse Treat %V 41 %P 252-60 %8 2011 Oct %G eng %U http://www.sciencedirect.com/science/article/pii/S0740547211000973 %N 3 %R 10.1016/j.jsat.2011.05.001 %0 Journal Article %J Addiction %D 2013 %T Methadone Dosing and Prescribed Medication Use in a Prospective Cohort of Opioid-Dependent Pregnant Women %A Cleary, B %A Murphy, Deirdre J %A Gallagher, Paul J %A Fahey, T %K Dosage %K dosing %K Methadone %K Neonatal Abstinence Syndrome %K Pregnancy %K withdrawal %X Aims This study aimed to (i) describe methadone dosing before, during and after pregnancy, (ii) to compare the incidence of neonatal abstinence syndrome (NAS) between those with dose decreases and those with steady or increasing doses and (iii) to describe prescribed medication use among opioid-dependent pregnant women. Design Prospective cohort study. Setting Two Irish tertiary care maternity hospitals. Participants A total of 117 pregnant women on methadone maintenance treatment (MMT) recruited between July 2009 and July 2010. Measurements Electronic dispensing records from addiction clinics and the Primary Care Reimbursement Service were used to determine methadone doses and dispensed medications in the year preceding and the month following delivery. The Finnegan score was used to determine need for medical treatment of NAS. Findings Of the 117 participants, sufficient dosing data were available for 89 women treated with MMT throughout pregnancy; 36 (40.4%) had their dose decreased from a mean pre-pregnancy dose of 73.3 mg [standard deviation (SD) 25.5] to a third-trimester dose of 58.0 mg (SD 26.0). The corresponding figures for those with increased doses (n = 31, 34.8%) were 70.7 mg (SD 25.3) and 89.7 mg (SD 21.0), respectively. The incidence of medically treated NAS did not differ between dosage groups. Antidepressants were dispensed for 29 women (25.7%) during pregnancy, with the rate decreasing from pre-pregnancy to postpartum. Benzodiazepines were prescribed for 43 women (38.0%). Conclusion In the Irish health service, opioid-dependent women frequently have their methadone dose decreased during pregnancy but this does not appear to affect the incidence of the neonatal abstinence syndrome in their babies %B Addiction %V 108 %P 762-768 %8 02/2013 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/23216809 %N 7 %R doi: 10.1111/add.12078 %0 Journal Article %J Addiction %D 2010 %T Methadone dose and neonatal abstinence syndrome-systematic review and meta-analysis %A Cleary, B %A Donnelly, Jean %A Strawbridge, Judith D %A Gallagher, Paul J %A Fahey, T %A Clarke, Mike %A Murphy, Deirdre J %K Cohort Studies %K Databases, Bibliographic %K Dose-Response Relationship, Drug %K Female %K Humans %K Infant, Newborn %K Methadone %K Narcotics %K Neonatal Abstinence Syndrome %K Opioid-Related Disorders %K Pregnancy %K Pregnancy Complications %K Prenatal Exposure Delayed Effects %K Randomized Controlled Trials as Topic %K Severity of Illness Index %X AIM: To determine if there is a relationship between maternal methadone dose in pregnancy and the diagnosis or medical treatment of neonatal abstinence syndrome (NAS). METHODS: PubMed, EMBASE, the Cochrane Library and PsychINFO were searched for studies reporting on methadone use in pregnancy and NAS (1966-2009). The relative risk (RR) of NAS was compared for methadone doses above versus below a range of cut-off points. Summary RRs and 95% confidence intervals (CI) were estimated using random effects meta-analysis. Sensitivity analyses explored the impact of limiting meta-analyses to prospective studies or studies using an objective scoring system to diagnose NAS. RESULTS: A total of 67 studies met inclusion criteria for the systematic review; 29 were included in the meta-analysis. Any differences in the incidence of NAS in infants of women on higher compared with lower doses were statistically non-significant in analyses restricted to prospective studies or to those using an objective scoring system to diagnose NAS. CONCLUSIONS: Severity of the neonatal abstinence syndrome does not appear to differ according to whether mothers are on high- or low-dose methadone maintenance therapy. %B Addiction %V 105 %P 2071-84 %8 2010 Dec %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2010.03120.x/abstract %N 12 %R 10.1111/j.1360-0443.2010.03120.x %0 Journal Article %J Am J Obstet Gynecol %D 2011 %T Methadone and perinatal outcomes: a retrospective cohort study %A Cleary, B %A Donnelly, Jean %A Strawbridge, Judith D %A Gallagher, Paul J %A Fahey, T %A White, Martin J %A Murphy, Deirdre J %K Age Factors %K Dose-Response Relationship, Drug %K Female %K Humans %K Infant, Newborn %K Methadone %K Narcotics %K Neonatal Abstinence Syndrome %K Odds Ratio %K Opiate Substitution Treatment %K Opioid-Related Disorders %K Pregnancy %K Premature Birth %K Retrospective Studies %K Risk Factors %K Smoking %K Treatment Outcome %X OBJECTIVE: The purpose of this study was to examine the relationship among methadone maintenance treatment, perinatal outcomes, and neonatal abstinence syndrome. STUDY DESIGN: This was a retrospective cohort study of 61,030 singleton births at a large maternity hospital from 2000-2007. RESULTS: There were 618 (1%) women on methadone at delivery. Methadone-exposed women were more likely to be younger, to book late for antenatal care, and to be smokers. Methadone exposure was associated with an increased risk of very preterm birth <32 weeks of gestation (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.40-4.34), being small for gestational age <10th percentile (aOR, 3.27; 95% CI, 2.49-4.28), admission to the neonatal unit (aOR, 9.14; 95% CI, 7.21-11.57), and diagnosis of a major congenital anomaly (aOR, 1.94; 95% CI, 1.10-3.43). There was a dose-response relationship between methadone and neonatal abstinence syndrome. CONCLUSION: Methadone exposure is associated with an increased risk of adverse perinatal outcomes, even when known adverse sociodemographic factors have been accounted for. Methadone dose at delivery is 1 of the determinants of neonatal abstinence syndrome. %B Am J Obstet Gynecol %V 204 %P 139.e1-9 %8 2011 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S0002937810012639 %N 2 %R 10.1016/j.ajog.2010.10.004 %0 Journal Article %J Addiction %D 2012 %T Methadone and perinatal outcomes: a prospective cohort study %A Cleary, B %A Eogan, Maeve %A O'Connell, Michael P %A Fahey, T %A Gallagher, Paul J %A Clarke, Tom %A White, Martin J %A McDermott, Christine %A O'Sullivan, Anne %A Carmody, Deirdre %A Gleeson, Justin %A Murphy, Deirdre J %K Methadone %K Neonatal Abstinence Syndrome %K Pregnancy %K small-for-gestational age %K withdrawal %X AIMS:   Methadone use in pregnancy has been associated with adverse perinatal outcomes and neonatal abstinence syndrome (NAS). This study aimed to examine perinatal outcomes and NAS in relation to (i) concomitant drug use and (ii) methadone dose. DESIGN:   Prospective cohort study. SETTING:   Two tertiary care maternity hospitals. PARTICIPANTS:   A total of 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010. MEASUREMENTS:   Information on concomitant drug use was recorded with the Addiction Severity Index. Perinatal outcomes included pre-term birth (<37 weeks' gestation), small-for-gestational-age (<10th centile) and neonatal unit admission. NAS outcomes included: incidence of medically treated NAS, peak Finnegan score, cumulative dose of NAS treatment and duration of hospitalization. FINDINGS:   Of the 114 liveborn infants 11 (9.6%) were born pre-term, 49 (42.9%) were small-for-gestational-age, 56 (49.1%) had a neonatal unit admission and 29 (25.4%) were treated medically for NAS. Neonates exposed to methadone-only had a shorter hospitalization than those exposed to methadone and concomitant drugs (median 5.0 days versus 6.0 days, P = 0.03). Neonates exposed to methadone doses ≥80 mg required higher cumulative doses of morphine treatment for NAS (median 13.2 mg versus 19.3 mg, P = 0.03). The incidence and duration of NAS did not differ between the two dosage groups. CONCLUSIONS:   The incidence and duration of the neonatal abstinence syndrome is not associated with maternal methadone dose, but maternal opiate, benzodiazepine or cocaine use is associated with longer neonatal hospitalization. %B Addiction %V 107 %P 1482-92 %8 2012 Aug %G eng %U http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2012.03844.x/abstract %N 8 %R 10.1111/j.1360-0443.2012.03844.x %0 Journal Article %J BMC Med Inform Decis Mak %D 2011 %T Developing an electronic health record (EHR) for methadone treatment recording and decision support %A Xiao, Liang %A Cousins, G %A Courtney, Brenda %A Hederman, Lucy %A Fahey, T %A Dimitrov, B %K Decision Support Techniques %K Drug Therapy, Computer-Assisted %K Electronic Health Records %K Episode of Care %K Humans %K Medical Record Linkage %K Methadone %K Practice Guidelines as Topic %K Semantics %K Systematized Nomenclature of Medicine %K User-Computer Interface %X BACKGROUND: In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. METHODS: A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. RESULTS: The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. CONCLUSIONS: The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. %B BMC Med Inform Decis Mak %V 11 %P 5 %8 2011 %G eng %U http://www.biomedcentral.com/1472-6947/11/5 %R 10.1186/1472-6947-11-5