women

Postpartum nonpharmacological adjunctive treatments for women with opioid use disorder were analysised in a narrative systematic review (Martinez and Allen, 2020).  Four studies were identified by the review and while they all reported improvements, overall it was not possible to draw conclusions on their effect on:

• reducing opioid use

Postpartum nonpharmacological adjunctive treatments included group or individual counseling or employemnt interventions.

Technology-based interventions for  women between 18 and 44 years old were found in a systematic review with meta-analysis (Hai et al., 2019, 15 studies, N = 3 488) to have an effect when compared to control conditions in:

• reducing substance use (alcohol and/or drugs) in the short term (follow-up ranged from 2 to 6 months) (d = 0.19, 95% CI = 0.02, 0.35, 13 studies)

The effect size estimates calculated separately for alcohol use and illicit drug use were 0.13 and 0.30 respectively and neither was statistically significant possibly due to low power of the studies.

Interventions examined included brief interventions modeled after the motivational interviewing approach or involving  periodically sending participants text messages to provide educational information to reduce substance use.

Evidence-based international guidelines (WHO, 2014) strongly recommend to advise opioid dependent pregnant women to use substitution treatment rather than attempt opioid detoxification.

Evidence does not support detoxification as a recommended treatment intervention as a result of low detoxification completion rates, high rates of relapse, and limited data regarding the effect of detoxification on maternal and neonatal outcomes beyond delivery (Dashe et al, 2018).

Evidence-based international guidelines (WHO, 2014) strongly recommend to advise opioid dependent pregnant women to start or continue substitution treatment with either methadone or buprenorphine.

Substitution treatment for pregnant women was found effective in 2 systematic review (EMCDDA 2014, Minozzi et al., 2020 - 3RCTS methadone vs buprenorphine, 1 RCT methadone vs slow-release morphine) in:

• reducing drop-out rates RR 0.66, 95 % CI 0.37 to 1.20, 3 studies, N=223 (no differences between OST medications)
• higher birth weight (may be higher in the buprenorphine group)
• reducing use during pregnancy (RR 1.81, 95 % CI 0.70 to 4.68, 2 studies, N=151)
• new-borns treated for neonatal abstinence syndrome RR 1.19, 95% CI 0.87 to1.63 (no differences between OST medications)

A systematic review with meta-analysis (Zedler et al, 2016, 3 RCTs, N= 223 and 15 observational studies, N=1 923), compared buprenorphine with methadone to treat pregnant women with opioid use disorder and found:

• lower risk of preterm birth (RR =0.40, 95 % CI = 0.18-0.91)
• greater birth weight (weighted mean difference (WMD) =277g, 95 % CI = 104-450)
• larger head circumference (WMD=0.90cm, 95 % CI=0.14-1.66)

A systematic review (Link et al., 2020, 5 RCTS, N= 1 875) found that substitution treatment with buprenorphine-naloxone have similar pregnancy outcomes when compared to women undergoing treatment with other forms of OST.

A more recent systematic review (Ordean & Tubman-Broeren, 2023, 5 studies) confirmed that using buprenorphine-naloxone during pregnancy lead to:

• reduced opioid use 
• similar gestation outcomes to those exposed to methadone, buprenorphine monotherapy, illicit opioids, or no opioids.

In a scientific review article commissioned by EBCOG (Vella et al, 2023) concerns have been raised, however, regarding current practices of initiating buprenorphine or buprenorphine/naloxone during pregnancy. It is noted that while substitution treatment with methadone and buprenorphine is widely accepted and recommended during pregnancy, the induction protocols used in some settings—particularly rapid induction methods used to initiate buprenorphine/naloxone—may carry unacknowledged risks, including potential miscarriage.

Psychosocial interventions for female drug-using offenders were found in a systematic review (Perry et al., 2015a) to have no significant effect (in different types of comparisons) in:

• reducing drug use

Interventions examined included collaborative case management, interpersonal psychotherapy, cognitive behavioural skills, single computerised intervention, dialectic behavioural therapy and case management and therapeutic community.

Pharmacological treatment (Buprenorphine) for female drug-using offenders was found in a systematic review (Perry et al., 2015) to have no different effect than placebo in:

• reducing drug use - self-reported at three months follow-up (RR 0.58, 95 % CI 0.25 to 1.35, 1 study, N=36)

Cognitive behavioural therapy was found in a systematic review (Perry et al., 2019a) to be more effective than therapeutic communities (one study of low quality) in:

•     reducing criminal activity, i.e. arrested (not for parole) violations at six months follow-up (RR 0.43, 95 % CI 0.25 to 0.77, N=314)

A systematic review (Wilson et al 2019) found no evidence to support an association between prescription monitoring programmes (PMPs) and:

• reduced opioid prescribing and dispensing;
• reduced non-medical prescription opioid use.

There were limited but inconsistent evidence supporting an association between PMPs and reduced Scedule II opioid prescribing and dispensing and reduced multiple provider use. Further studies are needed to determine the effectiveness of PMPs.

A systematic review without meta-analysis (Lin et al 2019, 13 studies) found no evidence of effect of telemedicine-delivered treatment (psychotherapy or pharmacotherapy) interventions for substance use disorders.

Studies examined suggest this type of intervention is an effective alternative, particularly where face-to-face treatment is less available, but more research is needed on their effectiveness.

A systematic review without meta-analysis  (Vold et al 2019, 7 RCT and 3 cohort studies, high risk of bias), found uncertain results on the effects of integrated care models on the treatment of infectious diseases in people with substance use disorders.