Opioid dependence during pregnancy: relationships of anxiety and depression symptoms to treatment outcomes

Abstract

Aims: To examine the relationship of anxiety and depression symptoms with treatment outcomes (treatment discontinuation, rates of ongoing use of illicit drugs and likelihood of preterm delivery) in opioid-dependent pregnant women and describe their use of psychotropic medications.

Design and setting: Secondary data analysis from a randomized clinical trial of treatment for opioid dependence during pregnancy.

Participants: A total of 175 opioid-dependent pregnant women, of whom 131 completed treatment.

Measurements: Symptoms of anxiety and depression were captured with the 15-item Mini International Neuropsychiatric Interview (MINI) screen. Use of illicit drugs was measured by urine drug screening. Preterm delivery was defined as delivery prior to 37 weeks' gestation. Self-reported use of concomitant psychotropic medication at any point during the study was recorded.

Findings: Women reporting only anxiety symptoms at study entry were more likely to discontinue treatment [adjusted odds ratio (OR) = 4.56, 95% confidence interval (CI) : 1.91-13.26, P = 0.012], while those reporting only depression symptoms were less likely to discontinue treatment (adjusted OR = 0.14, 95% CI : 0.20-0.88, P = 0.036) compared to women who reported neither depression nor anxiety symptoms. No statistically significant between-group differences were observed for ongoing illicit drug use or preterm delivery. A majority (61.4%) of women reported use of concomitant psychotropic medication at some point during study participation.

Conclusions: Opioid agonist-treated pregnant patients with co-occurring symptoms of anxiety require additional clinical resources to prevent premature discontinuation.

Trial registration: ClinicalTrials.gov NCT00271219.

Conflict of interest statement

Declaration of Interest:

This study was funded by the National Institute on Drug Abuse and National Center for Research Resources, National Institutes of Health.

The clinical trial was registered with ClinicalTrials.gov (Identifier: NCT00271219; Title: RCT Comparing Methadone and Buprenorphine in Pregnant Women).

H.J. discloses that she has received reimbursement for time and travel from Reckitt Benckiser.

G.F. discloses that she has received financial support and honoraria for presentations from Reckitt Benckiser, as well as financial support and honoraria for presentations from Schering Plough.

KEO’G discloses that he has received reimbursement for time from Reckitt Benckiser

© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Figures

Figure 1. Treatment discontinuation by symptom groups (n = 175)

Opioid-dependent pregnant women reporting anxiety only were more likely and those reporting depression only were less likely to discontinue treatment prior to delivering an infant than women reporting symptoms in neither category. Symptoms of anxiety and depression were determined at study entry using the 15-item MINI screen. Width of each bar is proportional to the number of participants in each group. Error bars represent 95% confidence interval.