Comparing methadone and buprenorphine maintenance with methadone-assisted withdrawal for the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes

Abstract

Pregnancy can motivate opioid-dependent women to seek substance abuse treatment. Research has demonstrated that although prenatal exposure to buprenorphine results in less severe neonatal abstinence syndrome (NAS) relative to prenatal methadone exposure, the maternal and other neonatal outcomes are similar for the two medications. Maternal and neonatal outcomes for opioid-dependent pregnant women receiving these medications have not been systematically ompared with methadone-assisted withdrawal. The present study provides an initial assessment of the relative efficacy of both methadone and buprenorphine maintenance versus methadone-assisted withdrawal in terms of neonatal and maternal delivery outcomes. Data were derived from (1) the MOTHER (Maternal Opioid Treatment: Human Experimental Research) study at the Johns Hopkins University Bayview Medical Center (JHBMC), or (2) retrospective records review of women who underwent methadone-assisted withdrawal at the JHBMC during the time period in which participants were enrolled in the MOTHER study. Compared with the methadone maintenance group, the methadone-assisted withdrawal group had a significantly lower mean NAS peak score (Means = 13.7 vs 7.0; P = 0.002), required a significantly lower mean amount of morphine to treat NAS (Means = 82.8 vs 0.2; P < 0.001), had significantly fewer days medicated for NAS (Means = 31.5 vs 3.9; P < 0.001), and remained in the hospital for a significantly fewer number of days, on average (Means = 24.2 vs 7.0; P < 0.019). Compared with the buprenorphine maintenance group, the methadone-assisted withdrawal group required a significantly lower mean amount of morphine to treat NAS (Means = 8.2 vs 0.2; P < 0.001) and significantly fewer days medicated for NAS (Means = 12.0 vs 3.9; P = 0.008). Findings suggest that it is possible for some opioid-dependent pregnant women to succeed with methadone-assisted withdrawal. Future research needs to more fully evaluate the potential benefits and risks of methadone-assisted withdrawal for the maternal-fetal dyad.

Treating Women Who Are Pregnant and Parenting for Opioid Use Disorder and the Concurrent Care of Their Infants and Children: Literature Review to Support National Guidance

“…The subsequent return to use of illicit opioids subjects pregnant women and the fetus to all the risks associated with such psychoactive substance use (eg, Kaltenbach et al, 1998 ; Mattick et al, 2009 ). Despite this concern regarding opioid use relapse, a secondary data analysis reported that a few studies support the concept that a small minority of women (16%) are successful at completing medication-assisted withdrawal and remaining in drug-free treatment until delivery (eg, Lund et al, 2012 ).…”

Treatment of Prescription Opioid Use Disorder in Pregnant Women

“…However, with exposure throughout pregnancy to opioid maintenance medications, there is a 60-80% incidence of neonatal abstinence syndrome, (4) often requiring a stay in the Neonatal Intensive Care Unit. It is unclear, however if maintenance medications, as opposed to medication-assisted withdrawal, should be the standard of care for pregnant women with prescription opioid use disorder (5) and if so, how best to taper these medications.…”

“…(10) Further, newborn outcomes including neonatal abstinence syndrome appear to be improved among women undergoing medication-assisted withdrawal. (5,10,39-41) At present, however it remains unclear if pregnant women with a prescription opioid use disorder that undergo medication-assisted withdrawal are at high risk for relapse to prescription opioid use or other drug use.…”

“…(5,10,39-41) One small study comparing opioid-assisted withdrawal (N=8) to methadone (N=12) or buprenorphine (N=5) in a comprehensive outpatient treatment program found no differences in maternal obstetric outcomes or urine drug screens between groups. (5) …”

Tapering from Methadone or Buprenorphine during Pregnancy: Maternal and Neonatal Outcomes in Norway 1996-2009

“…Published studies have mainly reported findings from relatively short in-patient periods of withdrawal/tapering for heroin-dependent pregnant women [11,12,14,26]. Gradual tapers over a longer period of time for pregnant women stabilized on methadone or buprenorphine is the preferred method described in the United States and Norwegian treatment guidelines [8,27], if a woman chose to taper during pregnancy [28].…”