Medication-Assisted Treatment With Methadone: Assessing the Evidence

Fullerton, Catherine A.; Kim, Meelee; Thomas, Cindy Parks; Lyman, D. Russell; Montejano, Leslie; Dougherty, Richard H.; Daniels, Allen S.; Ghose, Sushmita Shoma; Delphin-Rittmon, Miriam E.

doi:10.1176/appi.ps.201300235

Cited by 217 publications

(145 citation statements)

References 42 publications

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“…For women with heroin dependency especially, maintenance medications have been shown to improve both maternal and neonatal outcomes, including improved fetal growth and decreased preterm birth. 33,34 Neonatal Complications…”

Section: Discussionmentioning

confidence: 99%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

272

195

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BACKGROUND AND OBJECTIVES: Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is poorly described. Our objectives were to identify neonatal complications associated with antenatal opioid pain reliever exposure and to establish predictors of neonatal abstinence syndrome (NAS). METHODS:We used prescription and administrative data linked to vital statistics for mothers and infants enrolled in the Tennessee Medicaid program between 2009 and 2011. A random sample of NAS cases was validated by medical record review. The association of antenatal exposures with NAS was evaluated by using multivariable logistic regression, controlling for maternal and infant characteristics.RESULTS: Of 112 029 pregnant women, 31 354 (28%) filled $1 opioid prescription. Women prescribed opioid pain relievers were more likely than those not prescribed opioids (P , .001) to have depression (5.3% vs 2.7%), anxiety disorder (4.3% vs 1.6%) and to smoke tobacco (41.8% vs 25.8%). Infants with NAS and opioid-exposed infants were more likely than unexposed infants to be born at a low birth weight (21.2% vs 11.8% vs 9.9%; P , .001). In a multivariable model, higher cumulative opioid exposure for short-acting preparations (P , .001), opioid type (P , .001), number of daily cigarettes smoked (P , .001), and selective serotonin reuptake inhibitor use (odds ratio: 2.08 [95% confidence interval: 1.67-2.60]) were associated with greater risk of developing NAS.CONCLUSIONS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of NAS. WHAT'S KNOWN ON THIS SUBJECT:Although opioid pain relievers are commonly prescribed in pregnancy, their association with neonatal outcomes is not well described. Further, factors associated with development of neonatal abstinence syndrome, a neonatal opioid withdrawal syndrome is inadequately understood.WHAT THIS STUDY ADDS: Prescription opioid use in pregnancy is common and strongly associated with neonatal complications. Antenatal cumulative prescription opioid exposure, opioid type, tobacco use, and selective serotonin reuptake inhibitor use increase the risk of neonatal abstinence syndrome.

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Section: Discussionmentioning

confidence: 99%

Prescription Opioid Epidemic and Infant Outcomes

Patrick¹,

Dudley²,

Martin³

et al. 2015

Pediatrics

272

195

View full text Add to dashboard Cite

show abstract

“…Finally, regarding the effectiveness of opioid use disorder treatments, methadone and buprenorphine for opioid use disorder have been found to increase retention in treatment and to decrease illicit opioid use among patients with opioid use disorder involving heroin (151)(152)(153). Although findings are mixed, some studies suggest that effectiveness is enhanced when psychosocial treatments (e.g., contingency management, community reinforcement, psychotherapeutic counseling, and family therapy) are used in conjunction with medicationassisted therapy; for example, by reducing opioid misuse and increasing retention during maintenance therapy, and improving compliance after detoxification (154,155).…”

Section: Benefits and Harms Of Opioid Therapymentioning

confidence: 99%

“…As found in the contextual evidence review and supported by moderate quality evidence, opioid agonist or partial agonist treatment with methadone maintenance therapy or buprenorphine has been shown to be more effective in preventing relapse among patients with opioid use disorder (151)(152)(153). Some studies suggest that using behavioral therapies in combination with these treatments can reduce opioid misuse and increase retention during maintenance therapy and improve compliance after detoxification (154,155); behavioral therapies are also recommended by clinical practice guidelines (215).…”

mentioning

confidence: 99%

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Haegerich²,

2016

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“…21,25,[37][38][39][40] Recent metaanalyses have found that buprenorphine-naloxone and methadone were essentially equally efficacious across these traditional metrics when sufficient (i.e., medium-or high-dose, but not low-dose) buprenorphine-naloxone or methadone were used. 18,21,38 Risk of death While shown to be essentially as efficacious as methadone in clinical trials, 18,21,38 the partial opioid agonist buprenorphine-naloxone has several safety advantages over methadone (a full opioid agonist), including a reduced risk of fatal overdose because of its lower potential for respiratory depression.…”

Section: Initiate Opioid Agonist Treatment With Methadone When Treatmmentioning

confidence: 99%