The Effect of Methadone Dose Regimen on Neonatal Abstinence Syndrome

McCarthy, John J.; Leamon, Martin H.; Willits, Neil H.; Salo, Ruth

doi:10.1097/adm.0000000000000099

Cited by 45 publications

(37 citation statements)

References 28 publications

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“…In the sample of 62 women, the mean dose of opioid maintenance therapy at birth was 152 mg given in 2 to 6 doses per day, depending upon the woman's reported symptoms . NAS treatment was needed for 29% of the newborns . In this study, 81% of the women breastfed, and no specific intervention around breastfeeding was reported …”

Section: Resultsmentioning

confidence: 62%

“…Three studies compared the implementation of new, breastfeeding‐friendly policies with prior policies, and one study described the management of NAS, including breastfeeding recommendations, in Canadian neonatal intensive care units (NICUs) . Finally, one of the studies evaluated multiple daily dosing of methadone in pregnancy and included breastfeeding as an outcome of interest . All of the studies were retrospective chart reviews, except one study that used a survey to describe the array of NAS management practices in Canada …”

Section: Resultsmentioning

confidence: 99%

“…Finally, one of the studies evaluated multiple daily dosing of methadone in pregnancy and included breastfeeding as an outcome of interest . All of the studies were retrospective chart reviews, except one study that used a survey to describe the array of NAS management practices in Canada …”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Clark

2019

J Midwife Womens Health

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Introduction:Opioid use is epidemic in the United States. Opioid use disorder (OUD) in pregnancy, as well as neonatal abstinence syndrome, has quadrupled in the last decade, and opioid maintenance therapy is recommended for pregnant women with OUD. Breastfeeding is an important means of improving outcomes for these vulnerable women and newborns. The purpose of this study was to review current policy on breastfeeding and opioid maintenance therapy, the rates of breastfeeding among women in this population, and facilitators and barriers to implementing policy recommendations.Methods: CINAHL, PubMed, the Cochrane Database of Systematic Reviews, Embase, and Web of Science were searched. Inclusion criteria included publication between 2013 and 2018, English language, human only, and original data (except for policy statements). Studies were excluded if they did not report original data and did not examine breastfeeding for women on opioid maintenance therapy.Results: Eight policy statements and 17 original research studies were identified that met the search criteria. All the policy statements support breastfeeding for women who are stable on opioid maintenance therapy and do not have HIV. Despite this, rates of breastfeeding among women receiving opioid maintenance therapy remain low compared with women in the general population. Results of qualitative research indicates that women on opioid maintenance therapy face numerous barriers to breastfeeding, including misinformation from health care professionals. Quantitative research has only begun to identify interventions to improve breastfeeding outcomes in this population. Research was conducted primarily with white women receiving care at urban health care centers. Discussion:Practice lags behind policy in terms of supporting breastfeeding in women receiving opioid maintenance therapy. There is a need for more research that includes African American and rural women on opioid maintenance therapy, as well as quantitative research that uses findings from qualitative research to identify the best possible interventions for improving breastfeeding outcomes for women on opioid maintenance therapy and their newborns. One significant need is for health care provider education regarding these policies as well as best practices for providing breastfeeding education and support to this population. 545 RESULTSA total of 558 results were found, 154 duplicates were removed, and 404 titles and abstracts were screened. Of the 404 articles, 344 were excluded for failing to meet inclusion 546

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Section: Resultsmentioning

confidence: 62%

Section: Resultsmentioning

confidence: 99%

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Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Clark

2019

J Midwife Womens Health

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“…(44, 45) In a recent study, a mean methadone dose of 152 mg at delivery, divided into 2 to 6 doses per day resulted in 92% of mothers being illicit drug free at delivery and only 29% of neonates needing neonatal abstinence syndrome treatment. (46) An inadequate maternal methadone dosage may result in mild to moderate opioid withdrawal and cause fetal stress and increased likelihood for relapse. (47)…”

Section: Medication-assisted Therapymentioning

confidence: 99%

Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

Reddy¹,

Davis²,

Ren³

et al. 2017

Obstetrics &Amp; Gynecology

207

101

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In April 2016, the Eunice Kennedy Shriver National Institute of Child Health and Human Development invited experts to a workshop to address numerous knowledge gaps and to review the evidence for the screening and management of opioid use in pregnancy and neonatal abstinence syndrome. The rising prevalence of opioid use in pregnancy has led to a concomitant dramatic fivefold increase in neonatal abstinence syndrome over the past decade. Experts from diverse disciplines addressed research gaps in the following areas: 1) optimal screening for opioid use in pregnancy; 2) complications of pregnancy associated with opioid use; 3) appropriate treatments for pregnant women with opioid use disorders; 4) the best approaches for detecting, treating, and managing newborns with neonatal abstinence syndrome; and 5) the long-term effects of prenatal opioid exposure on children. Workshop participants identified key scientific opportunities to advance the understanding of opioid use disorders in pregnancy and to improve outcomes for affected women, their children, and their families. This article provides a summary of the workshop presentations and discussions.

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“…High-dose methadone (> 100 mg/day) may be more successful in reducing illicit use than doses under 100 mg/day in some pregnant women and does not appear to increase the severity of neonatal abstinence syndrome (McCarthy, Leamon, Parr, & Anania, 2005). Dose increases and/or divided dosing may be required with advancing gestation to achieve symptom control (McCarthy, Leamon, Willits, & Salo, 2015). A desire to reduce fetal exposure must be balanced by the central importance of treatment efficacy.…”

Section: Literature Review and Discussionmentioning

confidence: 99%

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

Goodman

Milliken

Theiler

et al. 2015

Journal of Dual Diagnosis

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Perinatal opioid use disorders negatively impact maternal and neonatal outcomes and are a public health problem of increasing severity. More than half of women with a substance use disorder have a history of posttraumatic stress disorder that, if not adequately addressed, can impede substance use disorder treatment. This case report describes complexities in the treatment of a pregnant woman with opioid use disorder and posttraumatic stress disorder and reviews the psychotherapeutic and pharmacologic approaches available to treat these co-occurring disorders in pregnancy. This case demonstrates the importance of early screening and intervention for cooccurring posttraumatic stress disorder in pregnant women who use substances, in a closely coordinated, multidisciplinary approach to improve outcomes for women and their infants.

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The Effect of Methadone Dose Regimen on Neonatal Abstinence Syndrome

Cited by 45 publications

References 28 publications

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Breastfeeding in Women on Opioid Maintenance Therapy: A Review of Policy and Practice

Opioid Use in Pregnancy, Neonatal Abstinence Syndrome, and Childhood Outcomes

A Multidisciplinary Approach to the Treatment of Co-occurring Opioid Use Disorder and Posttraumatic Stress Disorder in Pregnancy: A Case Report

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