TY - JOUR
KW - Adult
KW - Female
KW - Humans
KW - Infant, Newborn
KW - Neonatal Abstinence Syndrome/prevention & control
KW - Opioid-Related Disorders/therapy
KW - Outcome Assessment (Health Care)
KW - Pregnancy
KW - Pregnancy Complications/therapy
KW - Substance Withdrawal Syndrome
AU - Hendree E. Jones
AU - Mishka Terplan
AU - Marjorie Meyer
A1 - 
AB - Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater. Furthermore, while medically assisted withdrawal is being proposed as a public health strategy to reduce neonatal abstinence syndrome (NAS), current data do not support a reduction in NAS with medically assisted withdrawal relative to opioid agonist pharmacotherapy. Overall, the data do not support either benefit of medically assisted withdrawal or equivalence to opioid agonist pharmacotherapy for the maternal-newborn dyad. Medically assisted withdrawal increases the risk of maternal relapse and poor treatment engagement and does not improve newborn health. Treatment of chronic maternal disease, including opioid agonist disorder, should be directed toward optimal long-term outcome.
AD - UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (HEJ); Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University (HEJ); Behavioral Health System, Baltimore, MD (MT); Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT (MM).
BT - Journal of addiction medicine
C5 - Healthcare Disparities; Opioids & Substance Use
CP - 2
CY - United States
DO - 10.1097/ADM.0000000000000289
IS - 2
JF - Journal of addiction medicine
LA - eng
M1 - Journal Article
N2 - Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater. Furthermore, while medically assisted withdrawal is being proposed as a public health strategy to reduce neonatal abstinence syndrome (NAS), current data do not support a reduction in NAS with medically assisted withdrawal relative to opioid agonist pharmacotherapy. Overall, the data do not support either benefit of medically assisted withdrawal or equivalence to opioid agonist pharmacotherapy for the maternal-newborn dyad. Medically assisted withdrawal increases the risk of maternal relapse and poor treatment engagement and does not improve newborn health. Treatment of chronic maternal disease, including opioid agonist disorder, should be directed toward optimal long-term outcome.
PP - United States
PY - 2017
SN - 1935-3227; 1932-0620
SP - 90
EP - 92
EP - 
T1 - Medically Assisted Withdrawal (Detoxification): Considering the Mother-Infant Dyad
T2 - Journal of addiction medicine
TI - Medically Assisted Withdrawal (Detoxification): Considering the Mother-Infant Dyad
U1 - Healthcare Disparities; Opioids & Substance Use
U2 - 28079573
U3 - 10.1097/ADM.0000000000000289
VL - 11
VO - 1935-3227; 1932-0620
Y1 - 2017
Y2 - Mar/Apr
ER -