Materia Medica

From Page 29 and postpartum, drug and alcohol counseling (individual and group), group support programs that educate on breastfeeding and infant safety, Hepatitis C testing and treatment, medication for opioid use disorder, ability to refer to a methadone clinic, high-risk pregnancy care, and post-pregnancy services.12

Summary

Maternal substance abuse can result in neonatal abstinence syndrome. The chronic intrauterine exposure to opioids resulting in withdrawal symptoms in the neonate is known as neonatal opioid withdrawal syndrome. The associated symptoms experienced by neonates can be categorized into GI, CNS, and respiratory/metabolic symptoms. Nonpharmacotherapy is the standard of care when it comes to treatment of NAS and NOWS. If withdrawal symptoms are severe enough, pharmacotherapy can be initiated to mitigate them. Common substances of abuse are marijuana, cocaine, benzodiazepines, opioids, methamphetamine, and amphetamines. The short- and long-term effects on neonates who experience intrauterine exposure to substances of abuse should be monitored closely. After discharge from the hospital, the infant should be referred to a program or center that can provide comprehensive care and follow-ups. Within Allegheny County, there are many resources for those with opioid use disorders or those who struggle with substance abuse. There are specific programs designed for the pregnant population and mothers who are seeking help. This patient population requires special care and monitoring and within Allegheny County there are many resources designed to provide this care.

Citations

1. Holmes AP. NICU Primer for Pharmacists. Bethesda, MD: American Society of Health-System Pharmacists; 2016.

2. Pennsylvania opioids impact on families and children. Commonwealth of Pennsylvania Open Data Portal. https://data.pa.gov/stories/s/Pennsylvania-Opioids-Impact-on-Families-and-Childr/5jbf-sr7p/. Accessed March 27, 2023.

3. Jarlenski M, Krans EE, Chen Q, et al. Substance use disorders and risk of severe maternal morbidity in the United States. Drug Alcohol Depend. 2020;216:108236. doi:10.1016/j.drugalcdep.2020.108236

4. Jansson LM, Velez M, Harrow C. The opioid-exposed newborn: assessment and pharmacologic management. J Opioid Manag. 2009;5(1):47-55.

5. Patrick SW, Barfield WD, Poindexter BB, AAP COMMITTEE ON FETUS AND NEWBORN, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Neonatal Opioid Withdrawal Syndrome. Pediatrics. 2020;146(5):e2020029074

6. Yeoh SL, Eastwood J, Wright IM, Morton R, Melhuish E, Ward M, et al. Cognitive and motor outcomes of children with prenatal opioid exposure: a systematic review and meta-analysis. JAMA Netw Open. (2019) 2:e197025. 10.1001/jamanetworkopen.2019.7025

7. Osborn DA, Jeffery HE, Cole MJ. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Database Syst Rev. 2010;(10):CD002059

8. Agthe AG, Kim GR, Mathias KB, et al. Clonidine as an adjunct therapy to opioids for neonatal abstinence syndrome: a randomized, controlled trial. Pediatrics. 2009;123(5). Available at: www.pediatrics.org/cgi/content/ full/ 123/5/e849

9. Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol. 2013;56(1):91-96. doi:10.1097/ GRF.0b013e31827feeb9 adjacent lumbar vertebra, explaining her pain. My resident, from Georgia, upon seeing the findings said, in his deep southern drawl, “Fellahs, there’s a lesson here. Crocks daah (die), too.” Unfortunately for the patient, CT scanning and ultrasound exams had not been developed. The important lesson is that for most patients with a diagnosis of psychosomatic illness, the symptoms are real, and in fact a small number of these patients indeed have real abnormalities accounting for their symptoms.

10. Pregnancy and women’s recovery center: UPMC Magee-Womens Hospital. UPMC. https://www.upmc.com/locations/hospitals/ magee/services/obstetrics-and-gynecology/ obstetrics/magee-recovery-services/pregnancy-recovery-center. Accessed March 20, 2023.

11. Recovery engagement program: UPMC General Internal Medicine. UPMC. https:// www.upmc.com/services/internal-medicine/ opioid-recovery. Accessed March 20, 2023.

12. Recovery engagement program: UPMC General Internal Medicine. UPMC. https:// www.upmc.com/services/internal-medicine/ opioid-recovery. Accessed March 20, 2023.

13. How we help. Gateway Rehab. https://www.gatewayrehab.org/. Accessed March 20, 2023.

14. Medication-assisted treatment: Pittsburgh, PA - tadiso, Inc.. Quality Approved. https:// www.tadiso.org/medication-assisted-treatment/. Accessed March 20, 2023.

Sigmund Freud’s view of humor was that it was a conscious expression of thoughts that society usually suppressed or was forbidden.2 As long as the humor, in this case name- calling, is meant in a benign fashion, it is considered harmless.

However, in today’s politically divisive atmosphere, it is best to use humor only when you truly know your audience. As a good example, I remember the not so “good old days,” when it was expected that a speaker at a conference or a refresher course would tell jokes. Many of the “old timers” were very colorful characters. Today, fortunately, speakers are business-like and jokes are tacitly forbidden, since they are bound to offend someone. Finally, we should always remember that no matter how unpleasant some of our patients are to us, they are still our fellow human beings.

Dr. Daffner, associate editor of the ACMS Bulletin, is a retired radiologist who practiced at Allegheny General

He is emeritus clinical professor of Radiology at Temple University School of Medicine and is the author of nine

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