In Pregnancy, Buprenorphine Effective for Opioid Dependency

Alternative to methadone; tied to reduced treatment for neonatal abstinence syndrome

WEDNESDAY, Dec. 8 (HealthDay News) -- Buprenorphine is an acceptable alternative to methadone for the treatment of opioid dependency during pregnancy that appears to reduce the severity of neonatal abstinence syndrome (NAS), according to a study published in the Dec. 9 issue of the New England Journal of Medicine.

Hendrée E. Jones, Ph.D., of the Johns Hopkins University School of Medicine in Baltimore, and colleagues randomized 175 pregnant women with opioid dependency to buprenorphine or methadone.

The investigators found that treatment was discontinued by 18 percent of women in the methadone group and 33 percent in the buprenorphine group. In a comparison of 131 neonates whose mothers were followed to the end of pregnancy -- including 58 exposed to buprenorphine and 73 exposed to methadone -- the investigators found that those exposed to buprenorphine required significantly less morphine, experienced significantly shorter hospital stays, and had a significantly shorter duration of treatment for NAS. There were no significant differences in maternal or neonatal adverse events between patients receiving buprenorphine and those receiving methadone.

"Although there were no significant differences in overall rates of NAS among infants exposed to buprenorphine and those exposed to methadone, the benefits of buprenorphine in reducing the severity of NAS among neonates with this complication suggest that it should be considered a first-line treatment option in pregnancy," the authors write. "In selecting a course of treatment, however, clinicians should take into account the possibility of reduced adherence and the ceiling effect of this medication as compared with methadone."

Several authors disclosed financial relationships with various pharmaceutical companies, including Reckitt Benckiser, which provided buprenorphine medication and placebo products for the study.

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