Buprenorphine and Naloxone Compared With Methadone Treatment in Pregnancy

Wiegand, Samantha; Stringer, Elizabeth M.; Stuebe, Alison M.; Jones, Hendrée E.; Seashore, Carl; Thorp, John M.

doi:10.1097/aog.0000000000000640

Cited by 89 publications

(92 citation statements)

References 16 publications

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“…More recently, buprenorphine, a partial opioid agonist, has emerged as an alternative to methadone, showing a reduction in the duration and severity of NAS (78). A combination of buprenorphine plus the opioid antagonist naloxone, has also been used to treat pregnant women, demonstrating no adverse outcomes (79, 80), less severe NAS and shorter hospital stays compared to methadone (81). While more research is needed, methadone may be the treatment of choice for long-standing poly-substance abuse whereas buprenorphine may be the preferred treatment for prescription opioid abusers or those with shorter histories of dependence (82).…”

Section: Pregnant Women: Special Considerationsmentioning

confidence: 99%

Gender Considerations in Addiction: Implications for Treatment

Polak

Haug

Drachenberg³

et al. 2015

Curr Treat Options Psych

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Section: Pregnant Women: Special Considerationsmentioning

confidence: 99%

Gender Considerations in Addiction: Implications for Treatment

Polak

Haug

Drachenberg³

et al. 2015

Curr Treat Options Psych

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“…• Community-based, low dose buprenorphine + naloxone treatment became more widely available on rural and remote First Nations in Northwestern Ontario since 2012 • Although no harm has been shown in case reports of buprenorphine + naloxone in pregnancy, robust evidence is not yet available to support its use [13][14][15][16] • Guidelines recommend that women who are stable on buprenorphine + naloxone should be counseled to switch to the buprenorphine monoproduct that has been shown to be a safe and effective treatment for opioid dependence in pregnancy 17 • Buprenorphine is only available through a Health Canada special access program • In Northwestern Ontario, many women elect to remain on buprenorphine + naloxone and, in our region, the maternal and neonatal outcomes of this group are similar to women with no opioid exposure in pregnancy 9 How is neonatal abstinence syndrome managed in the region?…”

Section: Consensus Statementsmentioning

confidence: 99%

Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario

Jumah

Bishop

Franklyn

et al. 2017

Can J Public Health

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Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women. The initial workshop presented best practices and local experience in the management of opioid dependence in pregnancy while the second workshop asked participants to apply a local Indigenous worldview to the implementation of clinical, research and program priorities that were identified in the first workshop. Consensus statements developed by workshop participants identified improved transitions in care, facilitated access to buprenorphine treatment, stable funding models for addiction programs and a focus on Indigenous-led programming. Participants identified a critical need for a national strategy to address the effects of opioid use in pregnancy from a culturally safe, trauma-informed perspective that takes into account the health and well-being of the woman, her infant, her family and her community.KEY WORDS: Opiate dependence; pregnancy; Indigenous health services; rural population La traduction du résumé se trouve à la fin de l'article.

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“…12 Demonstrated advantages of buprenorphine over methadone include a diminished risk of overdose (due to low intrinsic receptor efficacy), less abrupt withdrawal, fewer drug-drug interactions, and prescriptions that are easier to obtain. 13,14 In addition, buprenorphine has been associated with an overall reduction in the incidence and severity of NAS compared to methadone.…”

Section: Maternal Agonist Treatment For Opiate-dependent Pregnant Womenmentioning

confidence: 99%

“…However, some studies suggest less need for treatment, lower peak NAS scores, and shorter length of hospitalization in neonates exposed to the combined formulation. 66, 67 …”

Section: Predictive Factorsmentioning

confidence: 99%

Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant

Kraft

Stover

Davis

2016

Seminars in Perinatology

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Opioid use in pregnancy has increased dramatically over the past decade. Since prenatal opioid use is associated with numerous obstetrical and neonatal complications, this now has become a major public health problem. In particular, in utero opioid exposure can result in neonatal abstinence syndrome (NAS) which is a serious condition characterized by central nervous system hyperirritability and autonomic nervous system dysfunction. The present review seeks to define current practices regarding the approach to the pregnant mother and neonate with prenatal opiate exposure. Although the cornerstone of prenatal management of opioid dependence is opioid maintenance therapy, the ideal agent has yet to be definitively established. Pharmacologic management of NAS is also highly variable and may include an opioid, barbiturate, and/or α-agonist. Genetic factors appear to be associated with the incidence and severity of NAS. Establishing pharmacogenetic risk factors for the development of NAS has the potential for creating opportunities for “personalized genomic medicine” and novel, individualized therapeutic interventions.

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Buprenorphine and Naloxone Compared With Methadone Treatment in Pregnancy

Cited by 89 publications

References 16 publications

Gender Considerations in Addiction: Implications for Treatment

Gender Considerations in Addiction: Implications for Treatment

Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario

Neonatal abstinence syndrome: Pharmacologic strategies for the mother and infant

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