Journal of addiction medicine
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Benzodiazepine (BZD) use is common in patients who are engaged in methadone as a treatment for opioid use disorder. BZD prescribing is generally discouraged for this patient population due to the increased risk of BZD dependence and BZD use disorder, medication-assisted treatment (MAT) discontinuation, and opioid-overdose death. However, some patients have concurrent mental health disorders, where BZD use may be clinically indicated. This study evaluates the impact of prescribed BZD on MAT outcomes. ⋯ Our findings suggest that prescribed BZD can be used during methadone MAT without impacting a patient's retention in MAT, but nonprescribed BZD use is predictive of treatment discontinuation. Importantly, we urge both the physician and patient to seek alternative clinical options to BZD prescribing, due to the potential for developing physical dependence (and BZD use disorder) to BZD and the risks of negative interactions with opioids.
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Case Reports
28-year-old Woman With Opioid Use Disorder Delivers Healthy Baby While in Custody: Addressing Forced Detox.
Opioid agonist treatment (OAT) in pregnancy reduces overdose risk, drug use, increases prenatal care engagement, and improves birth outcomes. Yet many pregnant women lack access to adequate treatment. OAT, while incarcerated, reduces subsequent overdose risk, improves continuation to treatment on release, and reduces recidivism. Yet most correction facilities do not follow evidence-based guidelines for treatment, resulting in destabilization and overdose. This case is unique in illustrating 1 example of a patient who is justice-involved during pregnancy and the postpartum period, and highlighting an area of advocacy that is under-reported in the medical literature. ⋯ The postpartum and postincarceration periods are 2 high-risk periods for women with OUD. OAT in and out of incarceration provided some stability and benefit, in the midst of a prenatal course that was fragmented by polysubstance use, hospitalization, and incarceration. Maintaining and prioritizing access to OAT for patients who are incarcerated is necessary, though not sufficient, to address the high risk of overdose. Empowering healthcare providers to advocate for incarcerated patients with OUD on an individual level is 1 key strategy to optimize addiction treatment for incarcerated people.