Postpartum changes in methadone maintenance dose

Pace, Christine A.; Kaminetzky, Leah B.; Winter, Michael; Cheng, Debbie M.; Saia, Kelley; Samet, Jeffrey H.; Walley, Alexander Y.

doi:10.1016/j.jsat.2014.04.004

Cited by 16 publications

(19 citation statements)

References 13 publications

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“…Dividing the dose of methadone in half (split dosing) is an approved protocol for women in the third trimester of pregnancy because of the shorter half-life and larger clearances of medications during pregnancy (eg, Bogen et al, 2013 ). There is mixed evidence supporting the need to lower methadone or buprenorphine doses after delivery ( Jones et al, 2008a ; Bogen et al, 2013 ; Pace et al, 2014 ; Bastian et al, 2016 ).…”

Section: Resultsmentioning

confidence: 99%

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

Klaman

Isaacs

Leopold

et al. 2017

Journal of Addiction Medicine

170

145

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Objectives:The prevalence of opioid use disorder (OUD) during pregnancy is increasing. Practical recommendations will help providers treat pregnant women with OUD and reduce potentially negative health consequences for mother, fetus, and child. This article summarizes the literature review conducted using the RAND/University of California, Los Angeles Appropriateness Method project completed by the US Department of Health and Human Services Substance Abuse and Mental Health Services Administration to obtain current evidence on treatment approaches for pregnant and parenting women with OUD and their infants and children.Methods:Three separate search methods were employed to identify peer-reviewed journal articles providing evidence on treatment methods for women with OUD who are pregnant or parenting, and for their children. Identified articles were reviewed for inclusion per study guidelines and relevant information was abstracted and summarized.Results:Of the 1697 articles identified, 75 were included in the literature review. The perinatal use of medication for addiction treatment (MAT, also known as medication-assisted treatment), either methadone or buprenorphine, within comprehensive treatment is the most accepted clinical practice, as withdrawal or detoxification risks relapse and treatment dropout. Medication increases may be needed with advancing pregnancy, and are not associated with more severe neonatal abstinence syndrome (NAS). Switching medication prenatally is usually not recommended as it can destabilize opioid abstinence. Postnatally, breastfeeding is seen as beneficial for the infant for women who are maintained on a stable dose of opioid agonist medication. Less is known about ideal pain management and postpartum dosing regimens. NAS appears generally less severe following prenatal exposure to buprenorphine versus methadone. Frontline NAS medication treatments include protocol-driven methadone and morphine dosing in the context of nonpharmacological supports.Conclusions:Women with OUD can be treated with methadone or buprenorphine during pregnancy. NAS is an expected and manageable condition. Although research has substantially advanced, opportunities to guide future research to improve maternal and infant outcomes are provided.

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Section: Resultsmentioning

confidence: 99%

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

Klaman

Isaacs

Leopold

et al. 2017

Journal of Addiction Medicine

170

145

View full text Add to dashboard Cite

show abstract

“…13 A larger study of 101 women found insignificant dose changes up to 3-month postpartum in 50% of women; the other 50% of women had either the same or higher doses postpartum. 14 The most provocative finding of our study is the lack of a postpartum decrease in methadone requirements up to 6-month postpartum. Recommendations from the Center for Substance Abuse Treatment, Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs, Treatment Improvement Protocol Series no.…”

Section: Discussionmentioning

confidence: 62%

“…11 Only recently have studies begun to build on this finding to assess the maternal impact of dose changes. [12][13][14] The objective of this study was to evaluate postpartum dose adjustments in women undergoing methadone for OUT during pregnancy.…”

mentioning

confidence: 99%

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Methadone for Opioid Use Treatment during Pregnancy: Trends in Postpartum Dose Adjustments

Ward

Christensen

2020

AJP Rep

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Objective This study examines methadone dose adjustment postpartum. Methods A retrospective study of women with methadone for opioid use treatment (OUT) during pregnancy was performed. Patient charts were reviewed and data were extracted. Methadone doses from five temporal data points for each patient were used: starting dose, day of delivery, and 1, 2, and 6 months postpartum. Results Over 26 months, 49 pregnancies to women using methadone for OUT were evaluated and 20 (41%) were included. The mean methadone starting dose was 47 mg, compared with 86 mg at the time of delivery. The mean dose postpartum remained unchanged from delivery and 75% of pregnancies required the same dose or higher 1 month postpartum. By 2 months postpartum, only 33% were able to decrease their methadone dose. Twelve pregnancies completed follow-up until 6 months postpartum; only 17% of patients were able to decrease their dose, with an overall mean dose decrease was 12%. There was no difference between the mean dose at delivery and the 6-month postpartum dose. Conclusion Patients using methadone for OUT during pregnancy achieved minimal dose decreases postpartum. Patients should be counseled that postpartum dose tapers may be challenging and about alternatives to methadone for OUT.

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“…The postpartum period is a vulnerable period where overdose can pose significant risks to maternal and child health and wellbeing. This time can be particularly challenging for mothers with opioid use disorder (OUD), given high rates of postpartum depression, fragmented transitions of care from prenatal to postpartum providers, lapses in insurance following delivery, physiological changes impacting medication dose for treatment of OUD and the shame and stigma experienced by women secondary to neonatal opioid withdrawal or loss of child custody .…”

Section: Introductionmentioning

confidence: 99%

Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery

et al. 2019

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Background and AimsOpioid-related overdose is increasingly linked to pregnancy-associated deaths, but factors associated with postpartum overdose are unknown. We aimed to estimate the strength of the association between maternal and infant characteristics and postpartum opioid-related overdose. Design Retrospective cohort study using a linked, population-level data set. Setting Massachusetts, United States. Conclusion Among women who delivered live infants in Massachusetts, USA between 2012 and 2014, maternal diagnosis of OUD, prior non-fatal overdose, infant diagnosis of NAS and high unscheduled health-care utilization appeared to be positively associated with postpartum opioid overdose. However, more than half of postpartum overdoses in that period were to women without a diagnosis of OUD. Engagement in methadone or buprenorphine treatment in the month prior to delivery was not sufficient to reduce the odds of postpartum overdose. Participants Women who delivered one or more live births from 2012 to 2014 (n = 174 517). Measurements The primary outcome was opioid-related overdose in the postpartum year. We used multivariable logistic regression to explore the independent associations of maternal (demographics, substance use, pregnancy) and infant [gestational age, birthweight, neonatal abstinence syndrome (NAS)] characteristics with postpartum opioid overdose. Findings were stratified by maternal opioid use disorder (OUD) diagnosis. Findings There were 189 deliveries to women who experienced ≥ 1 opioid overdose in the first year postpartum (11 of 10 000 deliveries). Among women with postpartum opioid overdose, 46.6% had an OUD diagnosis within 12 months before delivery. In our adjusted model, maternal diagnosis of OUD [adjusted odds ratio (aOR) = 3.61, 95% confidence interval (CI) = 1.73-7.51] and prior non-fatal overdose (aOR = 2.40, 95% CI = 1.11-5.17) were most strongly associated with postpartum overdose. After stratifying by OUD status, infant diagnosis of NAS (OUD + aOR = 2.03, 95% CI = 1.26-3.27; OUD -aOR = 2.79, 95% CI = 1.12-6.93) and high unscheduled health-care utilization (OUD + aOR = 2.27, 95% CI = 1.38-3.73; OUD -aOR = 2.11, 95% CI = 1.24-3.58) were positively associated with postpartum overdose in both groups. 90% of substance use-related pregnancy-associated deaths occurred after 6 weeks postpartum, compared with 60% of all other pregnancy-associated deaths [1][2][3][4][5]. In Massachusetts, the 7-12 months following delivery were

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Postpartum changes in methadone maintenance dose

Cited by 16 publications

References 13 publications

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

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

Methadone for Opioid Use Treatment during Pregnancy: Trends in Postpartum Dose Adjustments

Maternal and infant characteristics associated with maternal opioid overdose in the year following delivery

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