Treatment of opioid-dependent pregnant women: clinical and research issues

Abstract

This article addresses common questions that clinicians face when treating pregnant women with opioid dependence. Guidance, based on both research evidence and the collective clinical experience of the authors, which include investigators in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) project, is provided to aid clinical decision making. The MOTHER project is a double-blind, double-dummy, flexible-dosing, parallel-group clinical trial examining the comparative safety and efficacy of methadone and buprenorphine for the treatment of opioid dependence in pregnant women and their neonates. The article begins with a discussion of appropriate assessment during pregnancy and then addresses clinical management stages including maintenance medication selection, induction, and stabilization; opioid agonist medication management before, during, and after delivery; pain management; breast-feeding; and transfer to aftercare. Lastly, other important clinical issues including managing co-occurring psychiatric disorders and medication interactions are discussed.

Figure 1. Considerations in the Clinical Management of the Opioid-Dependent Pregnant Woman

Considerations specific to methadone and buprenorphine are listed on the left and right, respectively, of each module. Considerations that apply to both medications are listed in the shared panel at the bottom of each module.

Figure 1. Considerations in the Clinical Management of the Opioid-Dependent Pregnant Woman

Considerations specific to methadone and buprenorphine are listed on the left and right, respectively, of each module. Considerations that apply to both medications are listed in the shared panel at the bottom of each module.