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Methadone and Buprenorphine for the Management of Opioid Dependence in Pregnancy

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Abstract

This article provides an overview and discussion of the collective maternal, fetal and neonatal outcome research on women maintained on methadone or buprenorphine during pregnancy. Its focus is on an assessment of the comparative effectiveness of methadone and buprenorphine pharmacotherapy, with particular attention given to recent findings from the literature. Recommendations for clinical practice are outlined, and directions for future research are presented.

Findings from comparative studies of methadone and buprenorphine underscore the efficacy of both medications in preventing relapse to illicit opioid use in the treatment of opioid-dependent pregnant patients, as well as the simplicity of induction onto methadone and patient retention while receiving such therapy. Fetal monitoring suggests that buprenorphine results in less fetal cardiac and movement suppression than does methadone. The clinical implications of these findings need future exploration. For the neonate, evidence from studies using a wide range of designs, including retrospective chart reviews, prospective observational studies, and randomized clinical trials, show consistent results, with prenatal exposure to buprenorphine resulting in less severe neonatal abstinence syndrome relative to methadone.

Any medication given to pregnant women should be prescribed only after considering the risk: benefit ratio for the maternal-fetal dyad. Medication choices for each opioid-dependent patient during pregnancy need to be made on a patient-by-patient basis, taking into consideration the patient’s opioid dependence history, previous and current treatment experiences, medical circumstances and treatment preferences. Moreover, for a full remission of opioid addiction to be sustainable, both post-partum and across the lifespan, treatment providers must not rely solely on medication to treat their patients but should also utilize women-specific comprehensive treatment models that address the underlying multifaceted complexities of their patient’s lives.

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Acknowledgements

Two of the authors (HEJ and KK) were principal investigators of the MOTHER study. The authors alone are responsible for the content and writing of this article. No honorarium, grant, or other form of payment was given to any author or any other individual to produce the manuscript. All authors have approved the final manuscript.

KK was supported by the National Institute on Drug Abuse (RO1 DA 15738) during the preparation of this manuscript. Preparation of this paper was supported, in part, by the National Institute on Drug Abuse but this institute played no role in the (i) collection, analysis and interpretation of data; (ii) writing of the paper; or (iii) decision to submit or where to submit the paper for publication.

HEJ and KK received free active and placebo tablets from Reckitt-Benckiser Inc. to conduct the MOTHER study. HEJ has received reimbursement for time and travel from Reckitt-Benckiser Inc. for several presentations related to data from randomized controlled studies on this topic. LPF is funded as a consultant to Purdue Pharma, Stamford, CT, USA, for a project regarding NAS, which has not yet commenced.

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Jones, H.E., Finnegan, L.P. & Kaltenbach, K. Methadone and Buprenorphine for the Management of Opioid Dependence in Pregnancy. Drugs 72, 747–757 (2012). https://doi.org/10.2165/11632820-000000000-00000

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