Methadone, Buprenorphine, and Naltrexone for the Treatment of Opioid Use Disorder in Pregnant Women

Abstract

Pregnant women with opioid use disorder can be treated with methadone, buprenorphine, or naltrexone to reduce opioid use and improve retention to treatment. In this review, we compare the pregnancy outcomes of methadone, buprenorphine, and naltrexone in clinical trials and discuss the potential behavioral and developmental effects of these agents seen in offspring in animal studies. Important clinical considerations in the management of opioid use disorder in pregnant women and their infants are also discussed. Outside of pregnancy, buprenorphine is used in combination with naloxone to reduce opioid abuse and diversion. During pregnancy, however, the use of buprenorphine as a single agent is preferred to prevent prenatal naloxone exposure. Both methadone and buprenorphine are widely used to treat opioid use disorder; however, compared with methadone, buprenorphine is associated with shorter treatment duration, less medication needed to treat neonatal abstinence syndrome (NAS) symptoms, and shorter hospitalizations for neonates. Despite being the standard of care, medication-assisted treatment with methadone or buprenorphine is still underused, making it apparent that more options are necessary. Naltrexone is not a first-line treatment primarily because both detoxification and an opioid-free period are required. More research is needed to determine naltrexone safety and benefits in pregnant women. Animal studies suggest that changes in pain sensitivity, developmental processes, and behavioral responses may occur in children born to mothers receiving methadone, buprenorphine, or naltrexone and is an area that warrants future studies.

Physical birth outcomes in neonates prenatally exposed to buprenorphine - our first experiences

“…Methadone and buprenorphine are widely used to treat OUD. However, compared with methadone, buprenor-phine is associated with shorter treatment duration, less medication needed to treat NAS, and shorter hospitalization for neonates [7,10]. In our study, the mean length of hospital stay was 4.44 ± 1.13 days.…”

Medication-Assisted Treatment for Opioid-Use Disorder

“…123 However, methadone remains the primary suggested treatment for severe OUD during pregnancy. 124 In 2013, the American Academy of Pediatrics cited well-established data confirming minimal transmission of methadone and buprenorphine in breast milk. Subsequently, they asserted that appropriate medically monitored use of methadone and buprenorphine should not impair breast feeding if the mother so desires.…”

“…60,125,126 Despite good evidence of their efficacy, and no nefarious long-term fetal consequences, 127 both buprenorphine and methadone are, unfortunately, still underused during and after pregnancy. 124 Adolescence Adolescents with severe OUD are recommended to receive MAT by the American Academy of Pediatrics; however, research on these medications in adolescents is sparse. [128][129][130] Owing to regulatory issues, most methadone treatment programs do not accept patients younger than 18 years of age.…”

Opioid use disorder in pregnancy

“…Both medications are Food and Drug Administration (FDA) approved for OUD treatment in pregnancy and are recommended as first line options by leading experts in widely recognized organizations devoted to improving maternal and child health,2,8,12 including the American College of Obstetricians and Gynecologists (ACOG), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the World Health Organization (WHO). It is important to note that both treatments have the best outcomes when combined with robust psychosocial therapy and support through counseling, comorbid condition treatment, case management, parental support and education, and employment training 21. Ideally, pregnancy-specific programs should incorporate pharmacologic treatment, but most states do not have these programs 2.…”