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Published: 15 November 2011

Oral substitution treatment in pregnancy

Opioid-dependent expectant mothers are recommended to take methadone substitution treatment for the duration of their pregnancy. While many women will want to stop using opioids on finding out that they are pregnant, opioid withdrawal during pregnancy should be avoided because of the high risk of relapse to heroin use and the danger of withdrawal symptoms inducing miscarriage or premature labour (WHO, 2009). Prenatal exposure to methadone is, however, also associated with neonatal abstinence syndrome which requires medication and hospitalisation.

Buprenorphine is an alternative to methadone in maintenance treatment, and it has recently been studied in a sample of 175 opioid-dependent pregnant women enrolled in an international randomised controlled trial (Jones, H., et al., 2009a) carried out at six locations in the USA, one in Canada and one in Vienna. The women, who enrolled at between 13 and 30 weeks of pregnancy, were randomly assigned to receive methadone or buprenorphine, and were followed up with their newborn children until six months post-partum. As in other studies, buprenorphine was associated with a higher dropout rate (33 %) than methadone (18 %), but the children in the buprenorphine group appeared to need less morphine to treat neonatal abstinence syndrome and fewer days of hospitalisation. The study concluded that, when retained in treatment, pregnant women can be offered buprenorphine or methadone for treating opioid dependence in pregnancy (Jones, H., et al., 2009b).

Jones, H., Kaltenbach, K., Heil S., Stine, S., Coyle, M. et al. (2009a), RCT comparing methadone and buprenorphine in pregnant women, National Institute on Drug Abuse.

Jones, H., Kaltenbach, K., Heil, S., Stine, S., Coyle, M. et al. (2009b), 'Neonatal abstinence syndrome after methadone or buprenorphine exposure', New England Journal of Medicine 363, pp. 2320–31.

WHO (2009), Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence, World Health Organisation, Geneva.

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Page last updated: Friday, 28 October 2011