Buprenorphine-naloxone use in pregnancy: a systematic review and metaanalysis

Link, Heather; Jones, Hendrée E.; Miller, Lauren A.; Kaltenbach, Karol; Seligman, Neil S.

doi:10.1016/j.ajogmf.2020.100179

Cited by 44 publications

(34 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, a series of multiple linear regression analyses were conducted to examine the effect of the type of therapy on each outcome after controlling for the mother's socioeconomic, demographic, and delivery characteristics. More specifically, in our multiple regression, we controlled for maternal age, alcohol use during pregnancy, race, tobacco smoking quantity, ADI state ranking by zip code, medical insurance coverage, polysubstance use, parity status, prenatal care status, complications at delivery, gestational age, and maternal comorbidities of diabetes, hepatitis, depression, asthma, obesity, bipolar disorder, and autoimmune diseases, which were chosen based on prior research and theoretical risk on fetal outcomes [24,30,31]. We used appropriate measures of effect, p-value less than or equal to 0.05 and 95% confidence intervals (CIs), to determine significance.…”

Section: Study Outcomes and Data Analysismentioning

confidence: 99%

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Goshgarian¹,

Jawad²,

O’Brien³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundMaternal opioid exposure during pregnancy has various effects on neonatal health. Buprenorphine/naloxone and methadone are examples of medications for opioid use disorder (MOUD) used for the treatment of opioid use disorder (OUD). Research comparing the impacts of these MOUD modalities on neonatal outcomes when used to treat pregnant people with OUD remains limited. We evaluated the differences in outcomes between neonates with in-utero exposure to buprenorphine/naloxone versus methadone. MethodologyWe performed a retrospective cohort chart review between October 15, 2008, and October 15, 2019, evaluating mother/neonate dyads at two medical centers in Michigan. The charts of female patients, aged 18+, with OUD and buprenorphine/naloxone or methadone treatment, were examined. The charts of the corresponding neonates were also examined. Multiple regression analysis was performed. ResultsIn total, 343 mother/infant dyads were included: 99 patients were treated with buprenorphine/naloxone and 232 patients were treated with methadone. The buprenorphine/naloxone group had significant differences in maternal age, hepatitis status, asthma, gestational age in weeks, neonatal intensive care unit (NICU) length of stay (LOS), neonatal opioid withdrawal syndrome (NOWS) peak score, birth head circumference, and birth weight compared to the methadone group at baseline. Adjusted multivariable regression analysis demonstrated neonates with exposure to buprenorphine/naloxone had a NOWS peak score 3.079 points less (95% confidence interval (CI): -4.525, 1.633; p = 0.001) and NICU LOS 8.955 days less (95% CI: -14.399, -3.511; p = 0.001) than neonates exposed to methadone. ConclusionsNeonates with in-utero exposure to buprenorphine/naloxone had significantly lower NOWS scores and shorter NICU LOS compared to neonates with in-utero exposure to methadone. These findings demonstrate that buprenorphine/naloxone is potentially a more favorable treatment for the reduction in metrics representing adverse neonatal outcomes in pregnant people with OUD than methadone.

show abstract

Section: Study Outcomes and Data Analysismentioning

confidence: 99%

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Goshgarian¹,

Jawad²,

O’Brien³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…Third, there are no absolute contraindications to buprenorphine treatment. Buprenorphine is proven to be safe and effective during pregnancy, although the mono-formulated buprenorphine is recommended over the co-formulated buprenorphine-naloxone simply because there is no therapeutic value to the naloxone component [ 57 , 71 ]. The mono-formulated product is also recommended for patients with significant liver disease due to poor hepatic metabolism of naloxone.…”

Section: Managing Opioid Use Disordermentioning

confidence: 99%

Primary care management of Long-Term opioid therapy

et al. 2022

View full text Add to dashboard Cite

The United States underwent massive expansion in opioid prescribing from 1990–2010, followed by opioid stewardship initiatives and reduced prescribing. Opioids are no longer considered first-line therapy for most chronic pain conditions and clinicians should first seek alternatives in most circumstances. Patients who have been treated with opioids long-term should be managed differently, sometimes even continued on opioids due to physiologic changes wrought by long-term opioid therapy and documented risks of discontinuation. When providing long-term opioid therapy, clinicians should document opioid stewardship measures, including assessments, consents, medication reconciliation, and offering naloxone, along with the rationale to continue opioid therapy. Clinicians should screen regularly for opioid use disorder and arrange for or directly provide treatment. In particular, buprenorphine can be highly useful for co-morbid pain and opioid use disorder. Addressing other substance use disorders, as well as preventive health related to substance use, should be a priority in patients with opioid use disorder. Patient-centered practices, such as shared decision-making and attending to related facets of a patient’s life that influence health outcomes, should be implemented at all points of care. Key messages Although opioids are no longer considered first-line therapy for most chronic pain, management of patients already taking long-term opioid therapy must be individualised. Documentation of opioid stewardship measures can help to organise opioid prescribing and protect clinicians from regulatory scrutiny. Management of resultant opioid use disorder should include provision of medications, most often buprenorphine, and several additional screening and preventive measures.

show abstract

“…97 Although not SUD treatments in the formal sense, providers have the opportunity to offer referral to community recovery supports. Mutual support -Discuss up front how providers will address ongoing substance use and mandates to assess children's safety, noting that recurrence of substance use alone does not constitute child abuse/neglect -When reporting is required, involve the parent in the process for transparency -Discuss safe medication storage in a locked location out of reach of children -Ensure naloxone readily availability People who are pregnant -Time of increased motivation and stressors -Buprenorphine and methadone are standard of care and should be continued -Growing evidence that buprenorphine/naloxone does not need to be switched to buprenorphine mono product 113 -Do not stop MOUD if a patient becomes pregnant 114 -Expect a need for dose changes due to pregnancy physiology; the need for dose increases in pregnancy is not a marker of disease severity or stability 115 -Coordinate with Family Medicine or Obstetrics to provide wrap around services for people with OUD during pregnancy organizations, including Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery, recovery coaches, sober gyms, running groups, and 12-step yoga may be helpful for some patients. 98,99 Integrate Reproductive Health…”

Section: Creating a Therapeutic Environmentmentioning

confidence: 99%

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

et al. 2021

View full text Add to dashboard Cite

Opioid use disorder (OUD) is increasingly recognized as a chronic, relapsing brain disease whose treatment should be integrated into primary care settings alongside other chronic conditions. However, abstinence from all non-prescribed substance use continues to be prioritized as the only desired goal in many outpatient, primary care–based treatment programs. This presents a barrier to engagement for patients who continue to use substances and who may be at high risk for complications of ongoing substance use such as human immunodeficiency virus (HIV), hepatitis C virus (HCV), superficial and deep tissue infections, and overdose. Harm reduction aims to reduce the negative consequences of substance use and offers an alternative to abstinence as a singular goal. Incorporating harm reduction principles into primary care treatment settings can support programs in engaging patients with ongoing substance use and facilitate the delivery of evidence-based screening and prevention services. The objective of this narrative review is to describe strategies for the integration of evidence-based harm reduction principles and interventions into outpatient, primary care–based OUD treatment settings. We will offer specific tools for providers and programs including strategies to support safer injection practices, assess the risks and benefits of continuing medications for opioid use disorder in the setting of ongoing substance use, promote a non-stigmatizing program culture, and address the needs of special populations with ongoing substance use including adolescents, parents, and families. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06904-4.

show abstract

Buprenorphine-naloxone use in pregnancy: a systematic review and metaanalysis

Cited by 44 publications

References 29 publications

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Prenatal Buprenorphine/Naloxone or Methadone Use on Neonatal Outcomes in Michigan

Primary care management of Long-Term opioid therapy

Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings

Contact Info

Product

Resources

About