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Neonatal outcome following buprenorphine maintenance for opiate dependency

Published online by Cambridge University Press:  13 June 2014

John Fagan  and
Eamon Keenan
John Fagan*
Affiliation:
YoDA Addiction service, Glen Abbey Building, Belgard Road, Dublin 24, Ireland
Eamon Keenan
Affiliation:
Addiction Services, Bridge House, Cherry Orchard Hospital, Ballyfermot, Dublin 10, Ireland. Health Service Executive – Dublin Mid Leinster, Ireland
*
*Correspondence Email: johnc.fagan@hse.ie
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Abstract

Methadone substitution improves maternal and neonatal outcomes. However methadone induced neonatal abstinence syndrome (NAS) is common. Buprenorphine-exposed neonates may be at a lower risk of NAS. Currently in the Republic of Ireland, buprenorphine does not have a special licence for use in pregnancy. We describe here the history and neonatal outcomes of the first Irish woman maintained on buprenorphine during two pregnancies.

Supervised urinanalysis on this mother between and throughout both pregnancies did not reveal any illicit drug use. She delivered two post-term babies of normal birth weight and length. The second infant required treatment for NAS for 21 days with morphine sulphate. Although the use of buprenorphine in pregnancy does not remove the possibility of NAS, neonatal outcomes of buprenorphine-maintained women compares favourably to methadone. As the use of buprenorphine becomes more established in Ireland, the management of buprenorphine-exposed neonates will become more common.

Keywords

Neonatal abstinence syndromeOpiate dependencyBuprenorphine.
Type
Case reports
Information
Irish Journal of Psychological Medicine , Volume 25 , Issue 4 , December 2008 , pp. 141 - 144
Copyright
Copyright © Cambridge University Press 2008

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References

1.Smyth, BP, O'Brien, M. Children Attending Addiction Treatment Services in Dublin 1990-1999. Eur Addict Res 2004; 10: 68–74.CrossRefGoogle ScholarPubMed
2.European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). 2002 Annual report on the state of the drugs problem in the European Union and Norway. Luxembourg: Office for Official Publications of the European Communities, 2002.Google Scholar
3.Kelly, A, Carvallo, M, Teljeur, C. Prevalence of opiate use in Ireland 2000-2001. A 3-source Capture Recapture study, NACD 2003.Google Scholar
4.Farrell, M, Ward, J, Mattick, Ret al.Methadone maintenance treatment in opiate dependence: a review. BMJ 1994; 309: 997–1001.CrossRefGoogle ScholarPubMed
5.Central Methadone Treatment List, Drug Treatment Central Board, 30-31 Pearse Street, Dublin2.Google Scholar
6. Personal correspondence, Drug Liaison Midwives.Google Scholar
7.Finnegan, LP. Treatment issues for opioid-dependant women during the perinatal period. J Psychoactive Drugs 1991; 23; 191–201.CrossRefGoogle Scholar
8.Fischer, G. Treatment of opioid dependence in pregnant women. Addiction 2000; 95: 1141–44.CrossRefGoogle ScholarPubMed
9.Ward, J, Mattick, RP, Hall, W. Methadone maintenance during pregnancy. In: Ward, J, Mattick, RP, Hall, W eds. Methadone Maintenance Treatment and Other Opioid Replacement Therapies. Amsterdam: Harwood Academic Publishers 1998.Google Scholar
10.Hulse, G, Milne, E, English, DR, Holman, CDJ. The relationship between maternal use of heroin and methadone and infant birth weight. Addiction 1997; 92: 1571–1580.CrossRefGoogle ScholarPubMed
11.Osborn, DA, Cole, MJ, Jeffrey, HE. Opiate treatment for opiate withdrawal in newborn infants. Cochrane Library 2004, issue 3. Oxford: Update Software.Google Scholar
12.Finnegan, LP, Kron, RE, Connaughton, JF, Emich, JP. Assessment and treatment of abstinence in the infant of the drug dependent mother. Int J Clin Pharmacol 1975; 12: 19–32.Google ScholarPubMed
13.Scully, M, Geoghegan, N, Corcoran, P, Tiernan, M, Keenan, E. Specialized drug liaison midwife services for pregnant opioid dependent women in Dublin, Ireland. J Subst Abuse Treatm 2004; 26: 329–335.Google ScholarPubMed
14.Dashe, JS, Sheffield, JS, Olscher, DA, Todd, SJ, Jackson, GL, Wendel, GD. Relationship between maternal methadone dosage and neonatal withdrawal. Obstet Gynecol 2002; 100(6): 1244–1249.Google ScholarPubMed
15.Stimmel, B, Goldberg, J, Reisman, A, Murphy, RJ, Teets, K. Fetal outcome in narcotic-dependent women: the importance of the type of maternal narcotic used. Am J Drug Alcohol Abuse 1982–1983; 9(4): 383–395.CrossRefGoogle ScholarPubMed
16.Morrison, CL, Siney, C. A survey of the management of neonatal opiate withdrawal. Eur J Paediatrics 1996; 155: 323–326.CrossRefGoogle ScholarPubMed
17.Johnson, A, Greenough, A, Gerada, C. Maternal drug use and length of neonatal unit stay. Addiction 2002; 98:785–789.CrossRefGoogle Scholar
18.Coghlan, D, Milner, M, Clarke, Tet al.Neonatal abstinence syndrome, Ir Med J 1999; 92(1): 232–233, 236.Google ScholarPubMed
19.Seifert, J, Metzner, C, Paetzold, Wet al.Detoxification of opiate addicts with multiple drug use: a comparison of buprenorphine vs. methadone. Pharmacopsychiatry 2002; 35: 159–164.CrossRefGoogle ScholarPubMed
20.Jones, HE, Johnson, RE, Jasinski, DRet al.Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug Alcohol Depend 2005; 79: 1–10.CrossRefGoogle ScholarPubMed
21.Fischer, G, Johnson, RE, Eder, Het al.Treatment of opioid-dependent pregnant women with buprenorphine. Addiction 2000; 95(2): 239–244.CrossRefGoogle ScholarPubMed
22.Lacroix, I, Berrebi, A, Chaumerliac, C, Lapeyre-Mestre, M, Montastruc, JL, Damase-Michel, C. Buprenorphine in pregnant opioid-dependent women: first results of a prospective study. Addiction 2004; 99: 209–214.CrossRefGoogle ScholarPubMed
23.Schindler, SD, Eder, H, Ortner, R, Rohrmeister, K, Langer, M, Fischer, G. Neonatal outcome following buprenorphine maintenance during conception and throughout pregnancy. Addiction 2003; 98: 103–110.CrossRefGoogle ScholarPubMed
24.Johnson, RE, Jones, HE, Fischer, G. Use of buprenorphine in pregnancy: patient management and effects on the neonate. Drug Alcohol Depend 2003; 70(2 Suppl): S87–S101.CrossRefGoogle ScholarPubMed
25.Lewis, J, Ranee, MJ, Sanger, DJ. The Pharmacology and abuse potential of buprenorphine: a new antagonistic analgesic. Adv Subt Abuse 1983; 3: 103–154.Google Scholar
26.Jones, HE, Martin, PR, Heil, SHet al. Treatment of opioid-dependent Pregnant Women: Clinical and Research Issues. J Subst Abuse Treat in Press (available on-line).Google Scholar
27.Fischer, G, Ortner, R, Rohrmeister, Ket al.Methadone versus buprenorphine in pregnant addicts: a double-blind, double-dummy comparison study. Addiction 2006; 101: 275–281.CrossRefGoogle ScholarPubMed
28. NIDA – Directors Report – February 2005. www.nida.nih.gov/DirReports/DirRep205/DirectorsReport13.htmlGoogle Scholar
29.Abdel-Latif, ME, Pinner, J, Clews, S, Cooke, F, Lui, K, Oei, J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006: 117:1163–69.CrossRefGoogle ScholarPubMed
30.Auriacombe, M, Loustauneau, A. Medical treatment of the pregnant heroin addict – Review of the literature. In: Pregnancy and drug misuse update 2000. Proceedings: Seminar organised by the Co-operation Group to Combat Drug Abuse and Illicit Trafficking in Drugs (Pompidou Group). Drugs and Addiction. Council of Europe (2000), 39–74.Google Scholar
31. Summary of Product Characteristics (SPC) from the IPHA Electronic Medicines Compendium, www.medicines.ieGoogle Scholar
32.Centre for Substance abuse treatment. Medication-assisted treatment for opioid addiction in opioid treatment programs. US Department of Health and Human Services, Rockvill, MD (2005).Google Scholar
33.American Academy of Pediatrics Committee on Drugs. Neonatal drug withdrawal. Pediatrics 1998; 101: 1079–1085.CrossRefGoogle Scholar
34.Choo, RE, Huestis, MA, Schroeder, JR, Shin, AS, Jones, HE. Neonatal abstinence syndrome in methadone-exposed infants is altered by level of prenatal tobacco exposure. Drug Alcohol Depend 2004; 75: 253–260.CrossRefGoogle ScholarPubMed