Cigarette Smoking Case Study

3. Cigarette smoking. The extent of the patient’s smoking should be further discerned, as she admits to smoking one cigarette every 1-2 days. Given her desire to quit harmful substances and her success at quitting amphetamines and Zanex, it is possible that she is struggling to cease smoking and/or not admitting to the full extent of her use. She may be offered pharmacotherapy to aid in cessation. Both nicotine replacement therapy and Buproprion are first-line options in pregnancy [1]. Smoking cessation is particularly recommended in pregnant, opioid-addicted women, as smoking delays the onset and increases the severity of NAS [2], and smoking is also associated with increased post-partum narcotic requirements [3].

DISCUSSION:

Early screening. In the case of Ms. A, an opportunity was missed early in her pregnancy to identify her drug use and initiate prenatal care and addiction treatment. Prevalence of substance use is high among pregnant women and crosses all demographics. In a 2013 survey of pregnant women, 5% reported illicit drug use in the past month, 15.4% reported smoking cigarettes, and 9.4% reported drinking alcohol [4]. Early initiation of prenatal care and treatment should be the

Opiate substitution therapy with either methadone of buprenorphine has numerous advantages over continued drug use. These include oral route of administration, drugs of known dose and purity, reliable availability, reduced criminal activity, reduced withdrawal symptoms, consistent prenatal care, and improved maternal and neonatal outcomes [1]. Furthermore, treatment should be initiated as early as possible, as longer treatment duration has been shown to associated with increased length of gestation and birth weight [1]. Medication-assisted withdrawal has also been shown to be safe for both the mother and fetus, and it reduces NAS [5]. However, substitution therapy remains standard due to decreased rates of maternal recidivism