Scientific evidence and practical experience with methadone-assisted withdrawal of heroin-dependent pregnant patients

Abstract

Opioid dependence during pregnancy is a complex multi-faceted medical challenge that, if untreated, places the mother and child at risk for life threatening consequences. While methadone maintenance is the accepted standard of care for opioid dependent patients who are pregnant, there are limited circumstances when this life saving medication may not be an immediate option. Thus, this paper first highlights the data supporting the current USA clinical guidelines regarding medication-assisted withdrawal during pregnancy in opioid-dependent patients. Next, the results of a retrospective study comparing the maternal and neonatal consequences of methadone-assisted withdrawal to methadone maintenance in pregnant opioid-dependent patients are summarized. Given the generally poorer maternal outcomes of the medication-assisted withdrawal patients, these data provide renewed and current support for methadone-maintenance as the first-line treatment approach for opioid-dependent pregnant women.