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methadone is a complete μ-opioid receptor agonist and has been used since the 1970s as a gold standard treatment for ODV during pregnancy.1 It is distributed daily through comprehensive addiction treatment programs registered. At the present time, it is not legal for physicians outside of these approved treatment facilities to prescribe methadone to treat ODS (although the drug may be prescribed on a baseline basis). hospital for the continuation or initiation of MAT). All providers should be aware that there are significant drug interactions with methadone, including nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors, antiretroviral drugs, protease inhibitors, tricyclic antidepressants or rifampin. In addition, there is a risk of maternal respiratory depression and prolongation of the QTc interval.
buprenorphine is a partial agonist of the μ-opioid receptor, giving it an improved safety profile. It decreases the activity of complete opioid agonists (eg, methadone, heroin, morphine, oxycodone). Many recent evidences support the use of buprenorphine during pregnancy2 and is available as a mono-product (buprenorphine alone, Subutex), or as a product badociated with naloxone (buprenorphine / naloxone,[ParexempleSuboxone)Lecomposantnaloxonen'estpasactifs'ilestpriscorrectement(parvoiesublinguale)cependantunepatienteéprouveradessymptômesdesevrageimportantssielleinjectelemédicament(lbadoxoneestunantagonistedesopioïdesquivaremplacerlesopioïdesdesrécepteurs)PourcetteraisonleproduitcombinéestutilisépourpréveniruneutilisationintraveineuseinappropriéedelabuprénorphineHistoriquementlesprestatairesontexprimédespréoccupationsquantàlafournitureduproduitcombinépendantlagrossesseCependantlesdonnéesaccumuléescorroborentl'utilisationdebuprénorphine/naloxonependantlagrossesse[EgSuboxone)Thenaloxonecomponentisnotactiveiftakenintheproperfashion(sublingually);howeverapatientwillexperiencesignificantwithdrawalsymptomsifsheinjectsthemedication(naloxoneisanopioidantagonistthatwilldisplaceopioidsfromreceptors)ForthatreasonthecombinedproductisusedtopreventimproperintravenoususeofthebuprenorphineHistoricallyprovidershavehadconcernsaboutprovidingthecombinedproductinpregnancy;howeveraccumulatingdatasupportuseofbuprenorphine/naloxoneinpregnancy[parexempleSuboxone)Lecomposantnaloxonen'estpasactifs'ilestpriscorrectement(parvoiesublinguale);cependantunepatienteéprouveradessymptômesdesevrageimportantssielleinjectelemédicament(lbadoxoneestunantagonistedesopioïdesquivaremplacerlesopioïdesdesrécepteurs)PourcetteraisonleproduitcombinéestutilisépourpréveniruneutilisationintraveineuseinappropriéedelabuprénorphineHistoriquementlesprestatairesontexprimédespréoccupationsquantàlafournitureduproduitcombinépendantlagrossesseCependantlesdonnéesaccumuléescorroborentl'utilisationdebuprénorphine/naloxonependantlagrossesse[egSuboxone)Thenaloxonecomponentisnotactiveiftakenintheproperfashion(sublingually);howeverapatientwillexperiencesignificantwithdrawalsymptomsifsheinjectsthemedication(naloxoneisanopioidantagonistthatwilldisplaceopioidsfromreceptors)ForthatreasonthecombinedproductisusedtopreventimproperintravenoususeofthebuprenorphineHistoricallyprovidershavehadconcernsaboutprovidingthecombinedproductinpregnancy;howeveraccumulatingdatasupportuseofbuprenorphine/naloxoneinpregnancy3.4
For more information about OUD during pregnancy – The opioid crisis: prenatal and postnatal care
References:
1. American College of Obstetricians and Gynecologists. Opioid use and disorder of opioid use during pregnancy. Committee Opinion No. 711. Obstet Gynecol. 2017 130: 81-94.
2. Jones HE, Kaltenbach K, Heil SH el tal. Neonatal abstinence syndrome after exposure to methadone or buprenorphine. N Engl J Med. 2010; 363 (24): 2320-2331.
3. Debelak K, Morrone WR, KE O'Grady, Jones HE. Buprenorphine + naloxone in the treatment of opioid dependence during pregnancy, initial management data and results. Am J Addict. 2013; 22 (3): 252-254.
4. Lund IO, Fischer G, Welle-Strand GK et al. Comparison of buprenorphine + naloxone with buprenorphine and methadone in the treatment of opioid dependence in pregnancy: results for mothers and newborns. Subst Abuse. 2013; 7: 61-74.
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