American Society of Addiction Medicine: Two Conferences

Over the last month, I went to North Carolina’s Society of Addiction Medicine’s yearly conference, in Asheville, and the American Society of Addiction Medicine’s annual Medical-Scientific conference, in Atlanta. Both were great. Big chunks of both conferences were about aspects of opioid addiction and treatment, so I’ll have some great, brand new material for my blog over the next few weeks.

It was fun being around a group of like-minded people. The doctors and others at the conference were there because we all want to learn more about how to do a better job of treating people with addiction. I basked in the positive energy circulating at both conferences.

During one of the conferences, I heard about a new statement being issued by a committee made up of physician members of both the American College of Obstetricians and Gynecologists and of the American Society of Addiction Medicine. This statement, issued May of 2012, contained the committee opinion regarding opioid abuse, dependence, and addiction in pregnancy.

The seven-page report contained many good points, and the bottom line recommendations were much as I expected. Opioid use, abuse, and addiction are not uncommon in pregnant women, and are associated with worse outcomes than women not addicted to opioids. The current recommended standard of care for an opioid-dependent pregnant woman is methadone maintenance for the duration of the pregnancy. However, buprenorphine should also be considered, because of encouraging data, recently published, that shows milder neonatal withdrawal symptoms in babies born to moms on buprenorphine than on methadone.

The opinion paper does not recommend discontinuation of opioids during pregnancy due to the increased complications often seen during withdrawal: preterm labor, fetal distress and fetal death.

Did you ask if I sent a copy of this committee opinion to Angry Doctor, the subject of my April 15th blog? Oh, you know I did. With important parts highlighted with yellow marker.

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6 responses to this post.

  1. Posted by Robin Sherman on May 2, 2012 at 12:25 am

    I thank you so much for your work. I am a nurse practitioner at a methadone clinic in Vermont. It is so comforting to know you are out there caring as much as you do. I have come across some doctors who are very reluctant to treat opioid induced hypogonadism. Any suggestions?

    Reply

    • I meet resistance too. I refer patients to their primary care doctors, who often feel that since the hypogonadism is from the methadone, the patient should stop the methadone. These doctors don’t understand it’s not that easy, and that it’s a matter of weighing the benefits of methadone with the side effects. I try to gently educate when possible. Most doctors will listen and work with me, but some…they’re unteachable when it comes to addiction treatment.

      Reply

  2. I have to say here that I am truly glad I am not a woman. Public in general, views men as “tuff” and women as, well, I don’t want to say “weak”, but you know what I mean. I want to tell you that I have been in the delivery room several times with my (non) addict wife, and I am here to tell everyone, I am not tuff, and she most definitely is not weak. The last baby me and my wife had, the doc didn’t get there in time for the epidural, and it was me that was wrapped up in the curtain surrounding the bed, afraid to peek-not my tuff wife.

    There is a point to this, and here it is: I am an addict, and I now believe this with my whole heart (thx again Dr). I am so very glad I have never had to make the tuff decisions about what to do if I ever got pregnant, because again, just like in the delivery room, I may not be as tuff as I thought. You women that have to make these decisions have my respect. I should say I have new respect for the pregnant women I have seen in line. No, it’s not as safe as being “opiate free”, but I have to think it’s a heck of a lot more safe than drugs on the street, and even withdrawal.

    Btw, Dr. Burson I wanted to say a quick something. My wife’s grandpa grew up in Waynesville, NC, and they actually have a mountain home there. They spend summers there and winters back here in Florida. We have visited there every summer since I met my wife, and I just wanted to say it is absolutely beautiful. Hopefully, this year I will be able to experience it for the first time “drug free”. I just wanted to tell you that I am really looking forward to seeing it all just like I was a child. It will be an experience I know. Thanx again for everything! Oh and I promise I am not going to leave you alone now. 🙂

    Reply

  3. Just have to tell you something Dr. Went to the window at my clinic this morning set to decrease to 20mgs (from 25), and the nurse told me I couldn’t. There’s a new dr. at the clinic and they can no longer do decreases w/out his written authorization. Mind you, I have been decreasing for 6+ months now every 2 weeks. Have my schedule mapped out and everything, and now this. The nurse was very apologetic, and I did (eventually) let him know that I knew it wasn’t his fault. However, when I went to see the clinic director, he acted as if it was just a minor problem. This is my problem with them. They fail to realize that this is MY life here. He asked “what are we supposed to do, call every 1600 pts. and let them know of every change?”. I told him no, but the ones that are decreasing, yes, they need to be told so that their decreasing isn’t interrupted. I know you know that there are bad clinics, but I just figured I’d give you a little more about how bad this one is. Really, really sad, considering that I consider everything, and had they done my whole decrease thing in a different way, I probably could have been swayed towards thinking positive about them.

    Reply

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