Date: 18 Jun 2013
Buprenorphine Use in Pregnant Opioid Users: A Critical Review
- Michael Soyka
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Pregnancy in opioid users poses a number of problems to treating physicians. Most guidelines recommend maintenance treatment to manage opioid addiction in pregnancy, with methadone being the gold standard. More recently, buprenorphine has been discussed as an alternate medication. The use and efficacy of buprenorphine in pregnancy is still controversial. This article reviews the current database on the basis of a detailed and critical literature search performed in MEDLINE (206 counts). Most of the relevant studies (randomised clinical trials and one national cohort sample) were published in the last 2 years and mainly compared buprenorphine with methadone. Some studies are related to maternal outcomes, others to foetal, neonatal or older child outcomes. With respect to maternal outcomes, most studies suggest that buprenorphine has similar effects to methadone. Very few data from small studies discuss an effect of buprenorphine on neurodevelopment of the foetus. Neonatal abstinence syndrome is common in infants of both buprenorphine- and methadone-maintained mothers. As regards neonatal outcomes, buprenorphine has the same clinical outcome as methadone, although some newer studies suggest that it causes fewer withdrawal symptoms. Since hardly any studies have investigated the combination of buprenorphine with naloxone (which has been suggested to possibly have teratogenic effects) in pregnant women, a switch to buprenorphine monotherapy is recommended in women who become pregnant while receiving the combination product. These novel findings indicate that buprenorphine is emerging as a first-line treatment for pregnant opioid users.
Soyka M, Kranzler HR, van den Brink W, Krystal J, Moller HJ, Kasper S. The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of substance use and related disorders. Part 2: opioid dependence. World J Biol Psychiatry. 2011;12(3):160–87. doi:10.3109/15622975.2011.561872.PubMedCrossRef
Kleber HD, Weiss RD, Anton RF Jr, George TP, Greenfield SF, Kosten TR, et al. Treatment of patients with substance use disorders, second edition. American Psychiatric Association. Am J Psychiatry. 2007;164(4 Suppl):5–123.PubMed
Schottenfeld RS, Pakes JR, Oliveto A, Ziedonis D, Kosten TR. Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psychiatry. 1997;54(8):713–20 (A).
Kakko J, Gronbladh L, Svanborg KD, von Wachenfeldt J, Ruck C, Rawlings B, et al. A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence: a randomized controlled trial. Am J Psychiatry. 2007;164(5):797–803. doi:10.1176/appi.ajp.164.5.797.PubMedCrossRef
Soyka M, Kranzler HR, Berglund M, Gorelick D, Hesselbrock V, Johnson BA, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of substance use and related disorders, part 1: alcoholism. World J Biol Psychiatry. 2008;9(1):6–23. doi:10.1080/15622970801896390.PubMedCrossRef
ACOG Committee on Health Care for Underserved Women, American Society of Addiction Medicine. ACOG Committee Opinion No. 524: opioid abuse, dependence, and addiction in pregnancy. Obstet Gynecol 2012;119(5):1070–6. doi:10.1097/AOG.0b013e318256496e.
Minozzi S, Amato L, Vecchi S, Davoli M. Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database Syst Rev. 2008;(2):CD006318. doi:10.1002/14651858.CD006318.pub2.
Armstrong KA, Kennedy MG, Kline A, Tunstall C. Reproductive health needs: comparing women at high, drug-related risk of HIV with a national sample. J Am Med Womens Assoc. 1999;54(2):65–70, 8.
European Monitoring Centre for Drugs and Drug Addiction. Drug users and their children: from risks in pregnancy to targeted responses for families, a European snapshot. EMCDDA Research Monograph. Lisbon: EMCDDA; 2012.
Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. 2004.
American Society of Addiction Medicine. Policy statement on women, alcohol and other drugs, and pregnancy. 2011.
Zuspan FP, Gumpel JA, Mejia-Zelaya A, Madden J, Davis R. Fetal stress from methadone withdrawal. Am J Obstet Gynecol. 1975;122(1):43–6.PubMed
Wong S, Ordean A, Kahan M. Substance use in pregnancy. J Obstet Gynaecol Can. 2011;33(4):367–84.PubMed
Lingford-Hughes AR, Welch S, Peters L, Nutt DJ. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol. 2012;26(7):899–952. doi:10.1177/0269881112444324.PubMedCrossRef
Jones HE, Johnson RE, Jasinski DR, O‘Grady KE, Chisholm CA, Choo RE, et al. Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug Alcohol Depend. 2005;79(1):1–10. doi:10.1016/j.drugalcdep.2004.11.013.PubMedCrossRef
Gordon AL, Lopatko OV, Somogyi AA, Foster DJ, White JM. (R)- and (S)-methadone and buprenorphine concentration ratios in maternal and umbilical cord plasma following chronic maintenance dosing in pregnancy. Br J Clin Pharmacol. 2010;70(6):895–902. doi:10.1111/j.1365-2125.2010.03759.x.PubMedCrossRef
Vert P, Hamon I, Hubert C, Legagneur M, Hascoet JM. [Infants of drug-addicted mothers: pitfalls of replacement therapy]. Bull Acad Natl Med. 2008;192(5):961–9; discussion 9.
Eschenroeder AC, Vestal-Laborde AA, Sanchez ES, Robinson SE, Sato-Bigbee C. Oligodendrocyte responses to buprenorphine uncover novel and opposing roles of mu-opioid- and nociceptin/orphanin FQ receptors in cell development: implications for drug addiction treatment during pregnancy. Glia. 2012;60(1):125–36. doi:10.1002/glia.21253.PubMedCrossRef
Seligman NS, Salva N, Hayes EJ, Dysart KC, Pequignot EC, Baxter JK. Predicting length of treatment for neonatal abstinence syndrome in methadone-exposed neonates. Am J Obstet Gynecol. 2008;199(4):396 e1-7. doi:10.1016/j.ajog.2008.06.088.
Binder T, Vavrinkova B. Prospective randomised comparative study of the effect of buprenorphine, methadone and heroin on the course of pregnancy, birthweight of newborns, early postpartum adaptation and course of the neonatal abstinence syndrome (NAS) in women followed up in the outpatient department. Neuro Endocrinol Lett. 2008;29(1):80–6.PubMed
Welle-Strand GK, Skurtveit S, Jones HE, Waal H, Bakstad B, Bjarko L, et al. Neonatal outcomes following in utero exposure to methadone or buprenorphine: a National Cohort Study of opioid-agonist treatment of Pregnant Women in Norway from 1996 to 2009. Drug Alcohol Depend. 2013;127(1–3):200–6. doi:10.1016/j.drugalcdep.2012.07.001.PubMedCrossRef
Unger A, Jagsch R, Jones H, Arria A, Leitich H, Rohrmeister K, et al. Randomized controlled trials in pregnancy: scientific and ethical aspects Exposure to different opioid medications during pregnancy in an intra-individual comparison. Addiction. 2011;106(7):1355–62. doi:10.1111/j.1360-0443.2011.03440.x.PubMedCrossRef
O‘Connor A, Alto W, Musgrave K, Gibbons D, Llanto L, Holden S, et al. Observational study of buprenorphine treatment of opioid-dependent pregnant women in a family medicine residency: reports on maternal and infant outcomes. J Am Board Fam Med. 2011;24(2):194–201. doi:10.3122/jabfm.2011.02.100155.PubMedCrossRef
Ilett KF, Hackett LP, Gower S, Doherty DA, Hamilton D, Bartu AE. Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment. Breastfeed Med. 2012;7:269–74. doi:10.1089/bfm.2011.0096.PubMedCrossRef
Center for Substance Abuse Treatment (U.S.). Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) Series 40. DHHS Publication No. (SMA) 04-3939. DHHS publication. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2004.
Bailey B. Are there teratogenic risks associated with antidotes used in the acute management of poisoned pregnant women? Birth Defects Res A Clin Mol Teratol. 2003;67:133–40.
Lund I, Fischer G, Welle-Strand GK, O’Grady KE, Debelak K, Morrone WR, Jones HE. A comparison of buprenorphine + naloxone to buprenorphine and methadone in the treatment of opioid dependence during pregnancy: maternal and neonatal outcomes. Subst Abuse. 2013;7:61–74.
- Buprenorphine Use in Pregnant Opioid Users: A Critical Review
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- Michael Soyka (1) (2)
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- 1. Psychiatric Hospital, University of Munich, Nussbaumstr. 7, 80336, Munich, Germany
- 2. Private Hospital Meiringen, Willigen, 3860, Meiringen, Switzerland