Opioid use disorder in pregnancy: A strategy for using methadone

This is the authors' abstract. We don't add key points for this paper.

I n the United States, opioid use by patients who are pregnant more than quadrupled from 1999 to 2014. 1 Opioid use disorder (OUD) in the perinatal period is associated with a higher risk for depression, suicide, malnutrition, domestic violence, and obstetric complications such as spontaneous abortion, preeclampsia, and premature delivery.2 Buprenorphine and methadone are the standard of care for treating OUD in pregnancy.3,4 While a literature review found that maternal treatment with buprenorphine has comparable efficacy to treatment with methadone, 5 a small randomized, double-blind study found that compared to buprenorphine, methadone was associated with significantly lower use of additional opioids (P = .047).6 This suggests methadone has therapeutic value for patients who are pregnant.Despite the benefits of methadone for treating perinatal OUD, the physiological changes that occur in patients who are pregnant-coupled with methadone's unique pharmacologic properties-may complicate its use.Patients typically take methadone once a day, and the dose is titrated every 3 to 5 days to allow serum levels to reach steady state.7 During pregnancy, there are increases in both the volume of distribution and medication metabolism secondary to increased expression of the cytochrome P450 3A4 enzyme by the liver, intestine, and placenta.8 Additionally, as the pregnancy progresses, the rate of methadone metabolism increases.9 Methadone's half-life (20 to 35 hours) leads to its accumulation in tissue and slow release into the blood.10 As a Divided doses can help address the unique needs of patients who are pregnant Opioid use disorder in pregnancy: A strategy for using methadone EMIN KULIYEV/SHUTTERSTOCK DisclosuresThe authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.