Buprenorphine Versus Methadone for Opioid Dependence in Pregnancy

Noormohammadi, Arezo; Forinash, Alicia B.; Yancey, Abigail M.; Crannage, Erica F.; Campbell, Kristin; Shyken, Jaye M.

doi:10.1177/1060028016648367

Cited by 33 publications

(15 citation statements)

References 21 publications

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“…13 While ED studies have often excluded pregnant patients, research outside of emergency settings has shown that buprenorphine is safe and effective for pregnant patients. 28 Few studies examined additional clinical factors associated with improved treatment outcomes. Two cohort studies reported on factors associated with a decreased likelihood of remaining in treatment.…”

Section: Identification Of Patients For Inductionmentioning

confidence: 99%

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Cao¹,

Dunham²,

Simpson³

2020

OAEM

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ED-initiated addiction treatment holds promise for enhancing access to treatment for those with opioid use disorder (OUD). We present a literature review summarizing the evidence for buprenorphine induction in the ED including best practices for dosing, follow-up care, and reducing implementation barriers. A literature search of Pubmed, PsychInfo, and Embase identified articles studying OUD treatment in the ED published after 1980. Twenty-five studies were identified including eleven scientific abstracts. Multiple studies suggest that buprenorphine induction improves engagement in substance treatment up to 30 days after ED treatment. Many different induction protocols were presented, but no particular approach was best supported as criteria for induction and initial dosing vary widely. Similarly, transition of care models focused on either a "hub and spoke" model or "warm hand-offs" model, but no studies compared these approaches. Common barriers to implementing induction programs were provider inexperience, discomfort with addiction treatment, and limited time during the ED visit. No studies described the number of EDs offering induction. While ED buprenorphine induction is safe and enhances adherence to addiction treatment, uncertainty persists in how to best identify patients needing treatment, how to initiate buprenorphine, and how to enhance follow-up after ED-initiated treatment.

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Section: Identification Of Patients For Inductionmentioning

confidence: 99%

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Cao¹,

Dunham²,

Simpson³

2020

OAEM

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mentioning

confidence: 59%

“…There was no significant interaction between maternal maintenance treatment, gestational age and the likelihood of the baby receiving treatment for NAS, but only a small proportion of mothers in Gibson's study had been maintained on buprenorphine, and so there may be a type II error. Less severe NAS has been described by others for babies born to buprenorphine, compared to methadone-maintained mothers [9,10].Opioid withdrawal in the newborn is a complex and incompletely understood process with considerable longer-term effects. Increasing evidence points to adverse effects of opioid exposure upon the developing brain, with disproportionately small head circumference at birth and abnormal cortical visual evoked potentials [11][12][13].…”

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confidence: 92%

Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome

Mactier

2017

Addiction

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Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome Neonatal abstinence is difficult to assess in preterm infants, and the pros and cons of opioid replacement treatment are not clear. Clinicians should be aware of potential longer term issues for in-utero opioid-exposed children, regardless of neonatal manifestations.Gibson et al.'s retrospective study highlights an important issue, and adds to the debate around whether preterm infants are as likely as their term-born compatriots to develop significant neonatal abstinence syndrome (NAS) following in-utero opioid exposure [1][2][3]. In a large cohort (n = 102) of late preterm infants (gestational ages 34-36 weeks), the likelihood of receiving pharmacological treatment for NAS was not different compared to babies born at later gestations. These data are of particular interest in light of recent rises not only in the number of illicit opioid using mothers, but also in mothers on prescribed opioids, and indicate that concerns regarding the development of NAS following maternal opioid use in pregnancy should not influence timing of delivery [4,5].Although initiation of opioid replacement therapy was not influenced by gestation, median duration of treatment for late preterm infants was significantly shorter (by approximately 30%) compared to infants born at term. The authors postulate that this may be due to differences in placental opioid transport related either to gestation or concomitant illicit drug use, reduced cumulative opioid exposure, slower postnatal opioid excretion, neurological immaturity or a combination of factors [1,6]. In common with many other workers, Gibson et al. described use of a modified Finnegan score to assess the severity of NAS, but carers should be aware that no scoring system is well validated in the preterm population. A recent study compared preterm babies born at gestations ranging from 33 to 36 weeks with babies born at term, and noted gestation-related changes in a variety of Finnegan scoring criteria, some of which (e.g. tachypnoea) would increase, and some of which (including sleep disturbance and sweating) would decrease the cumulative Finnegan score [7]. NAS is ameliorated by rooming-in as well as by breast feeding [8]; in Gibson's study late preterm infants were more likely to be admitted to the neonatal unit, which may have occasioned closer observation and documentation of milder signs of NAS. None of the mothers of the late preterm infants was homeless, which may have been associated with a less unstable life-style and less illicit drug use, but numbers were small. There was no significant interaction between maternal maintenance treatment, gestational age and the likelihood of the baby receiving treatment for NAS, but only a small proportion of mothers in Gibson's study had been maintained on buprenorphine, and so there may be a type II error. Less severe NAS has been described by others for babies born to buprenorphine, compared to methadone-maintained mothers [9,10].Opioid ...

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“…Although unknown whether clinically significant, these characteristics of fetal physiology are indicative of positive fetal health 58. Other studies have also demonstrated an increase in fetal activity and heart rate variability,59 higher average gestational ages at birth, and higher average birth weights with buprenorphine treatment compared to methadone 60,61…”

Section: Treatment Options and Decisionsmentioning

confidence: 98%

Opioid use disorder in pregnancy

Harter¹

2019

Mental Health Clinician

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The number of pregnant people affected by the opioid epidemic in the United States continues to rise. The following key aspects of opioid use disorder in pregnancy are explored through the progression of a pregnancy via a patient case: treatment options, treatment decisions, substance use screening, dosing modifications, and other aspects of peripartum care. Many factors affect opioid use disorder treatment choices during pregnancy; however, when a pregnant person is medically eligible for a therapy and multiple options are available locally, the ultimate decision regarding treatment selection should be left up to the patient and strong support services provided. This approach to treatment results in optimal maternal and neonatal outcomes and long-term maternal engagement and retention in care.

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Buprenorphine Versus Methadone for Opioid Dependence in Pregnancy

Cited by 33 publications

References 21 publications

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

<p>Prescribing Buprenorphine for Opioid Use Disorders in the ED: A Review of Best Practices, Barriers, and Future Directions</p>

Commentary on Gibson et al. (2017): Gestational age and the severity of neonatal abstinence syndrome

Opioid use disorder in pregnancy

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