Lessons learned from a comparison of evidence‐based research in pregnant opioid‐dependent women

Abstract

Early treatment enrolment combined with contingency management contributes to reduced illicit drug use throughout pregnancy, surprisingly without influencing neonatal outcome parameters.

Recent trends in treatment admissions for prescription opioid abuse during pregnancy

“…Medication assisted therapy is standard of care for opioid dependent pregnant women (ACOG Committee on Health Care for Underserved Women & American Society of Addiction Medicine, 2012; Jones, Finnegan, & Kaltenbach, 2012) with methadone as the standard medication for decades (Newman, Bashkow, & Calko, 1975). Methadone therapy leads to improved maternal medical status, decreased fetal morbidity, and better prenatal care utilization (Fullerton et al, 2014; Mattick, Breen, Kimber, & Davoli, 2009; Winklbaur-Hausknost et al, 2013). More recently, buprenorphine has emerged as an alternative to methadone with the possible benefit of a decrease in the severity and duration of NAS (Jones et al, 2012).…”

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

“…Relapse rates are high and repeated cycles of intoxication and withdrawal are associated with significant fetal distress that can lead to placental insufficiency and consequent pregnancy loss, intrauterine growth restriction (IUGR) and preterm labor and birth 5, 7, 8, 9. The accepted treatment for OUD during pregnancy is long‐acting opioid agonist medication‐assisted treatment (OMAT), such as methadone (MET) or buprenorphine (BUP), within the context of a comprehensive program of obstetric care and psychosocial interventions 5, 8, 10, 11, 12, 13, 14. Adequate medication treatment maintains stable opioid blood levels that reduce maternal craving for and use of heroin or other opioids and improves prenatal care and fetal/infant outcomes compared with untreated opioid use or opioid withdrawal 11, 15, 16.…”

Safe Management of Chronic Pain in Pregnancy in an Era of Opioid Misuse and Abuse

“…Ethically, there are difficulties with developing well‐designed studies of any type of medications or therapies in pregnancy due to the potential effects on the fetus. It is even more difficult to conduct research regarding analgesic medications, opioid substitution therapies, and opiate agonists due to the subjective nature of pain management (Winklbaur‐Hausknost et al., ). Issues that arise concern how the treatments will affect the neonate at delivery, whether the clinician's assessment of efficacy of treatment is congruent with that of the patient, and whether the treatment or lack of treatment could produce unfavorable outcomes in the mother, fetus, or neonate, or long term in the infant or child.…”

“…There are many studies about the use of methadone and buprenorphine as opioid substitution therapies to reduce the maternal and fetal risks of withdrawal during pregnancy in the setting of illicit opioid addiction. Most studies demonstrate a higher risk of NAS with methadone than with buprenorphine (Jones et al., ; Pritham et al., ; Unger et al., ; Winklbaur‐Hausknost et al., ), yet methadone has been the standard of care for opioid‐dependent pregnant women since the early 1970s due to the large number of well‐conducted studies. Knoppert () estimated the incidence of NAS to be as high as 70% when methadone is used for the treatment of opioid dependence in pregnancy and is not dose dependent.…”

“…The widely publicized multinational Maternal Opioid Treatment: Human Experimental Research (MOTHER) project (Jones et al., ), along with other studies in the United States and internationally, have contributed to the body of knowledge regarding the safety of opioid analgesics and opiate substitution therapies in pregnancy (WHO, ). Continued inclusion of pregnant women in clinical trials on opioid‐replacement therapies will provide additional evidence for the safety of these medications over illicit drugs (Winklbaur‐Hausknost et al., ). Although the incidence of NAS has increased due to the use of methadone as opioid‐replacement therapy (National Institute on Drug Abuse, ; Patrick et al., ), perinatal outcomes from episodic illicit opioid use and withdrawal are worse (Malek & Mattinson, ).…”