Methadone is currently the gold-standard for opioid addiction treatment during pregnancy. However, it is estimated that 60-80% of infants exposed to methadone in utero experience neonatal abstinence syndrome (NAS) substantial enough to prolong hospital stay. Buprenorphine (Subutex) is a partial opioid agonist used as an alternative to methadone for opioid addiction. The purpose of this study was to determine the effects of buprenorphine and the buprenorphine treatment program on maternal and neonatal outcomes in comparison to mother-infant pairs treated in the methadone program. Outcomes resulted here are limited to those of the newborn.
This is a retrospective chart review of women who have completed a full term pregnancy while being treated with buprenorphine (n=19) or methadone (n=64) through Boston Medical Center's Addiction in Pregnancy Program from 2004 to 2008. Outcomes evaluated included number of prenatal visits, pregnancy outcomes, infant NAS scores, number of infants requiring pharmacotherapy for NAS, duration of therapy, maximum therapeutic dose, and duration of infant hospital stay
Mothers participating in the buprenorphine program had more prenatal visits than those receiving methadone. Infants of mothers treated with buprenorphine had shorter median hospital stays vs. those treated with methadone (10 days vs 16 days, respectively, p<0.03). Additionally, 2 (11%) of infants of buprenorphine treated mothers required admission to NICU compared to 30 (47%) of infants of methadone treated mothers (p<0.006).
These results support previously reported safety and efficacy of buprenorphine as an alternative to methadone in treatment of opiate dependence during pregnancy. Other investigators have demonstrated a neonatal benefit to maternal buprenoprhine treatment. Our results indicate that, under specific treatment conditions, buprenorphine may confer greater neonatal benefit than previously reported.
© 2008 Mosby, Inc. Published by Elsevier Inc. All rights reserved.