TY - JOUR
KW - Adult
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - Drug Substitution
KW - Female
KW - Humans
KW - Infant, Newborn
KW - Methadone/therapeutic use
KW - Neonatal Abstinence Syndrome/prevention & control
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/rehabilitation
KW - Pregnancy
KW - Pregnancy Complications/rehabilitation
KW - Pregnancy Outcome
KW - Treatment Outcome
KW - Methadone
KW - buprenorphine
KW - opioid use disorder
AU - S. Johnson
AU - P. R. Martin
A1 - 
AB - BACKGROUND: Opioid use disorder during pregnancy is a growing health concern. Methadone maintenance is the treatment of choice but emerging data indicate buprenorphine is a viable alternative. Due to costs and limited accessibility of methadone, pregnant women may require transition from methadone to buprenorphine for maintenance treatment. OBJECTIVES: To assess safety and effectiveness of transitioning from methadone to buprenorphine when necessary during pregnancy. METHODS: A standardized protocol using low buprenorphine doses to minimize emergent withdrawal symptoms under careful obstetric and psychiatric monitoring was implemented in 20 pregnant women. Outpatient maternal and neonatal outcomes were assessed. RESULTS: Women maintained on an average methadone dose of 44 +/- 4.77 (20-100) mg/day (mean+/-standard error mean (SEM); range) were successfully transitioned to 12.60 +/- 0.8 (8-16) mg/day (mean+/-SEM; range) of buprenorphine. Within 4 weeks of transition, 15% had illicit drugs detected in urine drug screens. Ninety percent of women maintained outpatient follow-up until delivery. At delivery, 38.9% of mothers were exclusively adherent to buprenorphine (without use of illicit substances and/or other psychotropic medications); this resulted in significantly lower rates of neonatal abstinence syndrome (NAS) and shorter hospital stays. DISCUSSION: Pregnant women transitioned from methadone to buprenorphine maintenance showed maternal and neonatal outcomes comparable to studies of women on buprenorphine throughout pregnancy. Infants born to buprenorphine-maintained women who abstained from illicit substances and other prescribed psychotropic medications experienced less severe NAS and shorter hospitalizations compared with women with illicit substance use and other psychotropic medications. These findings suggest women can safely be transitioned from methadone to buprenorphine during pregnancy.
AD - a Department of Psychiatry , Vanderbilt University Medical Center , Nashville , TN , USA.; a Department of Psychiatry , Vanderbilt University Medical Center , Nashville , TN , USA.
BT - The American Journal of Drug and Alcohol Abuse
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 3
CY - England
DO - 10.1080/00952990.2017.1363218
IS - 3
JF - The American Journal of Drug and Alcohol Abuse
M1 - Journal Article
N2 - BACKGROUND: Opioid use disorder during pregnancy is a growing health concern. Methadone maintenance is the treatment of choice but emerging data indicate buprenorphine is a viable alternative. Due to costs and limited accessibility of methadone, pregnant women may require transition from methadone to buprenorphine for maintenance treatment. OBJECTIVES: To assess safety and effectiveness of transitioning from methadone to buprenorphine when necessary during pregnancy. METHODS: A standardized protocol using low buprenorphine doses to minimize emergent withdrawal symptoms under careful obstetric and psychiatric monitoring was implemented in 20 pregnant women. Outpatient maternal and neonatal outcomes were assessed. RESULTS: Women maintained on an average methadone dose of 44 +/- 4.77 (20-100) mg/day (mean+/-standard error mean (SEM); range) were successfully transitioned to 12.60 +/- 0.8 (8-16) mg/day (mean+/-SEM; range) of buprenorphine. Within 4 weeks of transition, 15% had illicit drugs detected in urine drug screens. Ninety percent of women maintained outpatient follow-up until delivery. At delivery, 38.9% of mothers were exclusively adherent to buprenorphine (without use of illicit substances and/or other psychotropic medications); this resulted in significantly lower rates of neonatal abstinence syndrome (NAS) and shorter hospital stays. DISCUSSION: Pregnant women transitioned from methadone to buprenorphine maintenance showed maternal and neonatal outcomes comparable to studies of women on buprenorphine throughout pregnancy. Infants born to buprenorphine-maintained women who abstained from illicit substances and other prescribed psychotropic medications experienced less severe NAS and shorter hospitalizations compared with women with illicit substance use and other psychotropic medications. These findings suggest women can safely be transitioned from methadone to buprenorphine during pregnancy.
PP - England
PY - 2018
SN - 1097-9891; 0095-2990
SP - 310
EP - 316
EP - 
T1 - Transitioning from methadone to buprenorphine maintenance in management of opioid use disorder during pregnancy
T2 - The American Journal of Drug and Alcohol Abuse
TI - Transitioning from methadone to buprenorphine maintenance in management of opioid use disorder during pregnancy
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 28829626
U3 - 10.1080/00952990.2017.1363218
VL - 44
VO - 1097-9891; 0095-2990
Y1 - 2018
ER -