Rapid Methadone and Concurrent Slow-Release Oral Morphine Titration in a Pregnant Fentanyl User
Bibliographic record
Abstract
ABSTRACT Background: Methadone is a first-line option for medication-assisted treatment (MAT) of opioid use disorder in pregnancy. However, titration requires low dose initiation and slow titration to avoid respiratory suppression. This presents a problem in pregnancy when subtherapeutic doses may lead to preterm labor and stillbirth. Slow-release oral morphine (SROM) has a superior safety profile in terms of respiratory risks and Qt prolongation but there are fewer studies to support the use and therefore is typically reserved as the third line after methadone and buprenorphine have failed. Together methadone and SROM titrated concurrent may offer an opportunity to optimize the dose of MAT while reducing the time needed to reach a therapeutic dose. Case Summary: We report the case of a pregnant fentanyl user in the second trimester, presenting with threatened preterm labor, stabilizing on a therapeutic dose of methadone and SROM while in a hospitalized setting. Discussion: Over a 7-day period, while admitted to a hospitalized setting, this patient stabilized on a total morphine dose of 1000 mg (divided as 80 mg of methadone and 360 mg of SROM). There were no episodes of oversedation or respiratory suppression during her hospitalization. This case report describes a rapid method to concurrently titrate methadone and SROM to reach therapeutic doses of MAT that can reduce illicit opioid use in pregnancy. Historique: La méthadone est une option de premier choix pour le traitement médicalement assistés (MAT) des troubles liés à l’utilisation d’opioïdes pendant la grossesse. Cependant, la titration nécessite une initiation à faible dose et une titration lente afin d’éviter une suppression respiratoire. Cela pose un problème pendant la grossesse lorsque des doses subthérapeutiques peuvent entraîner un travail prématuré et une mortinatalité. La morphine orale à libération prolongée (MOLP) a un profil de sécurité supérieur en termes de risques respiratoires et d’allongement de l’intervalle Qté, mais il y a moins d’études pour soutenir son utilisation et donc, elle est généralement réservée en troisième ligne après l’échec de la méthadone et de la buprénorphine. L’association de la méthadone et de la MOLP titrée simultanément peut offrir l’occasion d’optimiser la dose de MAT tout en réduisant le temps nécessaire pour atteindre une dose thérapeutique. Résumé du cas: Nous rapportons le cas d’une utilisatrice de fentanyl enceinte au deuxième trimestre, présentant un danger de travail prématuré, se stabilisant sur une dose thérapeutique de méthadone et de MOLP pendant son hospitalisation. Discussion: Sur une période de 7 jours, alors qu’elle était admise en milieu hospitalier, cette patiente s’est stabilisée sur une dose totale de morphine de 1000 mg (divisée en 80 mg de méthadone et 360 mg de MOLP). Il n’y a eu aucun épisode de sédation excessive ou de suppression respiratoire pendant son hospitalisation. Ce rapport de cas décrit une méthode rapide pour titrer simultanément la méthadone et la MOLP afin d’atteindre des doses thérapeutiques de MAT qui peuvent réduire l’utilisation illicite d’opioïdes pendant la grossesse.
Stored with the screening record, where it is evidence for the labels above.
How this classification was reachedexpand
The three-model screen
all 5,600 screened works →All three models called this out of scope.
Case report of rapid methadone and slow-release morphine titration in a pregnant fentanyl user; a clinical management report.
The case report concerns treatment of opioid use disorder during pregnancy, not research itself.
Clinical case report of methadone and SROM titration in a pregnant fentanyl user.
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".