Neonatal Abstinence Syndrome After Methadone or Buprenorphine Exposure

Abstract

cians can impress upon their local health systems the importance of this issue, which should lead to changes in messaging to patients themselves. The use of social media on the internet should not be undervalued in these efforts as well. Finally, all women with gestational diabetes mellitus and T1 and T2 diabetes deserve careful follow-up after a first pregnancy, preparing for a second pregnancy. These women are likely to understand the importance of tight prepregnancy control and will benefit from programs designed to keep them up-to-date and educated regarding the current standards.As we face an increasing epidemic of T2 diabetes, there will be even more pregnant women with this disease. We must draw upon the resources of the entire health care system to ensure these women are in tight control and on the correct medications before pregnancy. In doing so, we are likely to not only improve health outcomes, but also to lower the high health care costs from complications of pregnancy.-ABC) ABSTRACTThe recommended treatment for opioid dependence in pregnant women is methadone, a full mu-opioid agonist. However, in utero exposure to methadone is associated with neonatal abstinence syndrome (NAS) that is characterized by hyperirritability of the central nervous system and a dysfunctional autonomic nervous system. Management of NAS often requires prolonged hospitalization and pharmacologic intervention. A partial mu-opioid agonist, buprenorphine, has been investigated as an alternative treatment for opioid dependence but relatively few studies of this drug have been conducted in pregnant women. Some prospective open-label and controlled studies suggest that NAS occurring in neonates treated prenatally with buprenorphine was less likely to require treatment than NAS in neonates exposed to prenatal methadone. However, the results of these studies have been inconsistent.This double-blind, randomized, controlled study compared the use of buprenorphine and methadone for management of pregnant women with opioid dependency. The study subjects were 175 pregnant opioid-dependent women enrolled at 8 international sites. A total of 131 of these women completed the trial; 58 (44%) were patients receiving buprenorphine and 73 (56%) were women treated with methadone. The 5 primary neonatal outcomes included the number of neonates requiring treatment for NAS, the peak NAS score, the total amount of morphine needed to treat NAS, length of hospital stay, and head circumference. The P values for all group comparisons were calculated according to prespecified thresholds for significance. Neonatal Complications 191

Neonatal Drug Withdrawal

“…Infants born to mothers treated with buprenorphine had shorter hospital stays (10 vs 17.5 days), had shorter treatment durations for NAS (4.1 vs 9.9 days), and required a lower cumulative dose of morphine (1.1 vs 10.4 mg) compared with infants born to mothers on methadone maintenance. 48 …”

One Good Decision: The Policy Argument for Extended Release Naltrexone in the Criminal Justice Setting

“…During the 24 week treatment phase, individuals assigned to the ER naltrexone arm had a significantly longer median time to relapse (10.5 weeks versus 5.0 weeks; p < 0.001), a lower relapse rate (43 % versus 64 % of participants; p < 0.001) risks associated with agonist-based MAT use during pregnancy are well-documented: Agonistbased MAT use during pregnancy is linked to adverse effects to the fetus and newborn, including physical dependence and withdrawal, retardation of growth, and neonatal respiratory depression at high doses. Perhaps the best described of these effects is neonatal abstinence syndrome (NAS), which has been found to be associated with both buprenorphine and methadone treatment (Jones et al 2010). Notably, the incidence of NAS has risen dramatically over the past decade: between 2004 and 2013, neonatal ICU admissions of NAS patients increased almost four-fold, from 7 to 27 cases/1000 admissions (Tolia et al 2015).…”

Behavioural outcomes of four-year-old children prenatally exposed to methadone or buprenorphine: a test of three risk models

“…Prenatal exposure to opioids such as methadone and buprenorphine causes neonatal abstinence syndrome (NAS) in approximately half of all prenatally-exposed infants (Jones et al, 2010). While both methadone and buprenorphine act by binding to opioid receptors in the central nervous system, methadone is a full mu-opioid agonist while buprenorphine is only a partial mu-opioid agonist (Robinson, 2002).…”

“…More recently, buprenorphine has also been recommended as treatment for opioid-dependent pregnant women (Jones et al, 2010). Compared to opioid-dependent women who do not receive substitution treatment, pregnant women in opioid maintenance therapy (OMT) programs take better care of their health, have better treatment attendance, and are less likely to use illicit substances or engage in other risk behaviors (Fischer et al, 2000).…”