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Tittel Versjon Status
Publiseringsdato
Utgiver(e) Publikasjonstype
  • Norsk tittel - The Norwegian national clinical guideline on pregnancies in opioid maintainance treatment (OMT) and the follow-up of the child and the familily untill the child starts school
  • Engelsk tittel -
  • Versjon - 1
  • Status - Publisert
  • IS-nr -
  • ISBN -
  • DOI -
  • Revisjonsdato -
  • Neste revisjon -
  • Publikasjonsdato - 02.05.2011
  • Utløpsdato -
  • Utgiver(e) - Norwegian Directorate of Health
  • Redaktør -
  • Publikasjonstype - Nasjonale retningslinjer
 

Translate of summary in OMT guidelines for pregnant women and the families

The national treatment guideline for pregnant women in opioid maintenance treatment (OMT) and the follow-up of families until the child reaches school age provides specific and knowledge-based recommendations. The guideline is organised in such a way that the chapters primarily follow the patient care process, and the clinical recommendations start with the pregnancy, move on to the stay in hospital in connection with the birth and neonatal period and conclude with the follow-up for infants and toddlers. The basic aim is to offer a fixed follow-up programme, whilst at the same time emphasising the importance of individual assessments. In addition, a number of organisational recommendations are made.

Chapter 1 concerns the mandate, patient target group, the target group for the guideline and the objectives for the follow-up of children and their families.

Chapter 2 provides a brief account of the underlying international knowledge within the field. It is noted that the guideline is supplemented by the Norwegian Knowledge Centre for the Health Services’ (NOKC) summary, a knowledge summary concerning breastfeeding, and the Directorate of Health’s own summary of international research concerning child development. This is then followed by a summary of Norwegian surveys of pregnant women in OMT and follow-up studies as regards children.  By way of conclusion, areas where there is a lack of knowledge and future research requirements are highlighted.

The method used in the preparation of the guideline is described in Chapter 3. This Chapter also describes the Directorate of Health’s understanding of the knowledge concept, how the recommendations have been graded, and  the use of ‘shall’, ‘should’ and ‘may’ in the recommendations.

Relevant legislation and regulations are described in Chapter 4. There is a particular focus on the regulations concerning OMT and the national guideline for Medication Assisted Rehabilitation for opioid addiction, which form the basis for the present guideline. Furthermore, emphasis is placed on the principle that the follow-up programme must be as normalised as possible to ensure that patients accept the service and to prevent unnecessary stigmatisation. The coordination of the services, professional accountability and the need for competence development are described.

Chapter 5 gives an account of the patient’s rights as regards consent, involvement and information.  Ethical considerations associated with conflicts of interest and user involvement as part of the work to improve the service are described.

Pregnancy is the theme of Chapter 6. A focus is initially placed on contraceptive guidance and family planning for women in OMT. The chapter then goes on to consider what should happen when an OMT- pregnancy is discovered, who is responsible for implementing measures, information to the pregnant woman and if appropriate her partner, in addition to any assessments that should be carried out. An account is given of the work of the coordination team, the coordinating function and the use of individual plans and treatment plans. The preparations that should be made with regard to becoming a parent, the use of extended services for pregnant women or specialist health centres and the role of the child welfare service in the pregnancy are also central themes. Maternity care within the municipality and the specialist health care is described with a detailed description of what must be assessed in connection with the various pregnancy check-ups. The check-ups that should be performed at municipal level and in the specialist health care are specified, and the collaboration between the two management levels is an additional theme. Medical treatment using the OMT medications methadone or buprenorphine is the next theme and an in-depth discussion of the underlying knowledge that exists within this area is presented. The main recommendation is that methadone or buprenorphine should be maintained during pregnancy. The circumstances under which it may be appropriate to taper down OMT medications are described. Furthermore, a discussion is also presented concerning the distribution in the body of the OMT medications, urine samples, blood samples, the use of other medications, in addition to the use of alcohol and other drugs during pregnancy. Smoking during pregnancy and measures to stop/reduce smoking are discussed in particular. The need for further support and treatment in the form of outpatient care or institutional care is also covered. The use of withholding in institutions for pregnant women using alcohol or drugs in accordance with the enforcement provisions of the Health and Care Services Act is also considered. This chapter concludes with a discussion of birth preparations and people with opioid dependency not included in OMT.

Chapter 7 concerns the birth and neonatal period. By way of introduction, it is recommended that the regional health authorities designate a small number of hospitals within their region that can admit child-bearing women who are in OMT and other women where the newborn baby is expected to suffer from withdrawal symptoms. The birth is the next theme to be covered, with a discussion of the assessments to be made upon admission to hospital and a focus on pain-relief treatment both during and after delivery. A detailed account is given of the observations and treatment of neonatal abstinence syndrome (NAS). Additional themes include the period of stay in the delivery ward, breastfeeding and guidance in interaction between the neonate and the parents. The handling of OMT during the postnatal period, possible induction into OMT following birth, handling of any suspected drug abuse and follow-up of other needs among parents are described. The chapter concludes with a description of the hospital discharge process with a focus on the further follow-up of the child’s medical and psychosocial needs.

Chapter 8 covers the period of infants and toddlers. The first theme considers OMT medication and the care of children. The focus then moves on to collaboration and coordination for the follow-up of infants and toddlers, with the establishment of a coordination team and an individual plan for the child. A broad discussion then follows concerning the type of assessments that should be offered in order to determine the type and scope of measures. The improvement of parenting skills is described. The role of the well-baby clinic in municipal follow-up is described first, with a detailed account of when the various check-ups should be carried out and what should be focused on at different ages. The roles of the general practitioners, the use of nursery schools and child welfare services are also discussed. Municipal alcohol and drug services and other municipal measures are described. Under the role of specialist health services, it is recommended that a national resource centre and interdisciplinary team be established at the hospitals. The function of these teams and the check-ups that are offered is described in detail. Other themes in Chapter 8 include the role of the HELFO Patient Referral Unit, child and adolescent psychiatrist roles, and admission to institutions.

Chapter 9 begins with reference to the importance of providing appropriate accommodation and economic support to enable the family and the child to participate in society in the same way as other children. A focus is also placed on school, work and daytime activities for parents, and the significance of networks and possible measures to strengthen such networks. Adapted follow-up and the importance of not burdening the family any more than necessary are described to ensure that the family has the peace it need to function as a family. Known and suspected drug use is also considered. The safe storage of OMT medication is important, especially for families with young children. The chapter concludes by considering circumstances linked to care, with a discussion of the transfer of care, the involvement of the county social welfare board and contact with children placed outside the home.

Chapter 10 consists of the appendices. The first appendix is a summary of the 217 recommendations contained in the guideline. The second appendix specifies the special Norwegian measures for pregnant women and families with alcohol- and drug-related problems, and includes contact persons and contact information. The third appendix is the Directorate of Health’s overview of literature relating to research focusing on the children of OMT patients. The final appendix contains relevant assessment and investigation tools that can be used with regard to infants and toddlers.

Chapter 11 provides an overview of the references for research, guidelines, legislation and other documents on which the recommendations in the guidelines are based.