Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome

Jones, Hendrée E.; Johnson, Rolley E.; Jasinski, Donald R.; O’Grady, Kevin E.; Chisholm, Christian A.; Choo, Robin E.; Crocetti, Michael; Dudas, Robert A.; Harrow, Cheryl; Huestis, Marilyn A.; Jansson, Lauren M.; Lantz, Michael E.; Lester, Barry M.; Milio, Lorraine

doi:10.1016/j.drugalcdep.2004.11.013

Cited by 264 publications

(353 citation statements)

References 34 publications

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“…Of 1111 citations identified, 140 full‐text papers were assessed for eligibility, and 18 studies 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 (reported in 23 papers 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52) satisfied our inclusion criteria (Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

“…1). The only three RCTs 19, 20, 21 (six papers 19, 20, 21, 50, 51, 52) that have been conducted to date were included (223 participants; published 2005–10) (Supporting information, Table S2). Fifteen OBSs 18, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 46, 47, 48 (17 papers) 18, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 enrolled a total of 1923 participants in prospective 18, 34, 35, 36, 37, 38, 39, 41, 42, 45, 46, 47 ( n = 12) or retrospective 43, 44, 48 ( n = 3) cohort studies published 2001–15.…”

Section: Resultsmentioning

confidence: 99%

“…Among the seven studies 19, 20, 21, 35, 38, 39, 41 that assessed spontaneous fetal death, five medium ROB studies reported at least one (Supporting information, Table S5). The difference in treatment effect between BUP and MET was not significant from two RCTs 19, 20 and three OBSs 38, 39, 41 (Table 2 and Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies 19, 21, 34, 38, 39, 41, 43, 46, 48 that evaluated malformations or other defects at birth or pregnancy loss identified chromosomal defects and cardiovascular, central nervous system, craniofacial and musculoskeletal malformations (Supporting information, Table S7). Only two studies treated essentially all women with MET from preconception to end of pregnancy 41, 48.…”

Section: Resultsmentioning

confidence: 99%

“…Seventeen studies 18, 19, 20, 21, 34, 35, 36, 37, 38, 39, 41, 42, 43, 44, 45, 47, 48 reported preterm births. The effect estimate from three RCTs 19, 20, 21 indicated lower risk of preterm birth for BUP compared with MET.…”

Section: Resultsmentioning

confidence: 99%

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Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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AimsTo assess the safety of buprenorphine compared with methadone to treat pregnant women with opioid use disorder.MethodsWe searched PubMed, Embase and the Cochrane Library from inception to February 2015 for randomized controlled trials (RCT) and observational cohort studies (OBS) that compared buprenorphine with methadone for treating opioid‐dependent pregnant women. Two reviewers assessed independently the titles and abstracts of all search results and full texts of potentially eligible studies reporting original data for maternal/fetal/infant death, preterm birth, fetal growth outcomes, fetal/congenital anomalies, fetal/child neurodevelopment and/or maternal adverse events. We ascertained each study's risk of bias using validated instruments and assessed the strength of evidence for each outcome using established methods. We computed effect sizes using random‐effects models for each outcome with two or more studies.ResultsThree RCTs (n = 223) and 15 cohort OBSs (n = 1923) met inclusion criteria. In meta‐analyses using unadjusted data and methadone as comparator, buprenorphine was associated with lower risk of preterm birth [RCT risk ratio (RR) = 0.40, 95% confidence interval (CI) = 0.18, 0.91; OBS RR = 0.67, 95% CI = 0.50, 0.90], greater birth weight [RCT weighted mean difference (WMD) = 277 g, 95% CI = 104, 450; OBS WMD = 265 g, 95% CI = 196, 335] and larger head circumference [RCT WMD = 0.90 cm, 95% CI = 0.14, 1.66; OBS WMD = 0.68 cm, 95% CI = 0.41, 0.94]. No treatment differences were observed for spontaneous fetal death, fetal/congenital anomalies and other fetal growth measures, although the power to detect such differences may be inadequate due to small sample sizes.ConclusionsModerately strong evidence indicates lower risk of preterm birth, greater birth weight and larger head circumference with buprenorphine treatment of maternal opioid use disorder during pregnancy compared with methadone treatment, and no greater harms.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

et al. 2016

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Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

et al. 2020

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Key Points Question What is the geographic distribution across the US and prevalence of Medicaid-claimant obstetrician-gynecologists who are trained to prescribe buprenorphine? Findings In this cross-sectional study including 31 211 Medicaid-claimant obstetrician-gynecologists, fewer than 2% were trained to prescribe buprenorphine. In addition, these physicians were more likely to work in primarily suburban counties. Meaning Results of this study suggest that an opportunity exists for obstetrician-gynecologists to contribute to expanding the workforce of clinicians who can prescribe buprenorphine to further address the opioid epidemic’s association with maternal and infant morbidity and mortality.

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Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

Mattick

Kimber

Breen

et al. 2008

Cochrane Database of Systematic Reviews

311

127

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Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome

Cited by 264 publications

References 34 publications

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

Buprenorphine compared with methadone to treat pregnant women with opioid use disorder: a systematic review and meta‐analysis of safety in the mother, fetus and child

Prevalence and Geographic Distribution of Obstetrician-Gynecologists Who Treat Medicaid Enrollees and Are Trained to Prescribe Buprenorphine

Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

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