Clinical Management of Methadone Dependence During Pregnancy

Abstract

This is a review of the literature regarding the clinical management of pregnant women maintained on methadone treatment. The prevalence of opiate use, definition of opiate dependence, common concerns regarding methadone use in pregnancy, and maternal/fetal harm are addressed. Recommendations for nurses are synthesized from the clinical literature, clinical experiences, and the empirical literature. These recommendations address: antepartum issues including treatment, dosage and pharmacological considerations, medical conditions and lab tests, intrapartum issues, postpartum concerns including breastfeeding, neonatal withdrawal, and developmental effects associated with methadone.

The Effects of Maternally Administered Methadone, Buprenorphine and Naltrexone on Offspring: Review of Human and Animal Data

“…However, as methadone is an agonist, use of other opiates can still elicit morphine-like effects, with fatal overdose as a potential outcome [ 24 , 247 , 368 ]. For example, although sufficient methadone reduces or eliminates drug craving [ 213 , 384 , 393 ], in patients who fail to remain abstinent, methadone may attenuate the effects of, for example, heroin through cross-tolerance and increased competition for binding at μ-opioid receptor sites [ 76 , 107 , 311 , 384 ]. Another limitation with this pharmacotherapy is that the duration of withdrawal is protracted compared to withdrawal from heroin; consequently, detoxification from methadone has lower success rates compared to detoxification from other opioids [ 4 , 69 , 75 , 117 , 118 , 311 ].…”

Methadone & Buprenorphine Treatment During Pregnancy: What are the Effects on Infants?

“…For years, methadone was the only recommended pharmacotherapy in the United States for opioid‐ dependent pregnant women (Jones et al, 2005). The goals of methadone maintenance are to reduce physical stress associated with cycling between intoxication and withdrawal and to lower other health risks associated with intravenous drug use (Wilbourne, Wallerstedt, Dorato, & Curet, 2000). But methadone treatment is controversial during pregnancy because neonates often require treatment for withdrawal, which can be more severe and prolonged than that experienced by infants of heroin‐addicted mothers (Beauman, 2005).…”

Social Determinants of Methadone in Pregnancy: Violence, Social Capital, and Mental Health

“…Methadone maintenance treatment (MMT) is considered appropriate for women who report opiate dependence for more than one year and show signs of current drug withdrawal (Wilbourne, Wallerstedt, Dorato, & Curet, 2001). Methadone is an opiate similar in structure to heroin; yet, its effect lasts up to 24 hours, making it easier for the addicts to achieve "normal" social behavior (as opposed to daily drug-seeking behavior) (Burns et al, 2006).…”