Treating Pregnant Opioid Dependent Women: Examining Buprenorphine and Methadone

Treating Pregnant Opioid Dependent Women: Examining Buprenorphine and Methadone dr shabeel pn

Presentation Goals ,[object Object],[object Object],[object Object]

Studies of Medication During Pregnancy ,[object Object],[object Object],[object Object]

Goals of Opioid Agonist Treatment ,[object Object],[object Object],[object Object],[object Object]

Methadone is effective during pregnancy ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Methadone is not a “Magic Bullet” Medication

The NAS of Opioid Exposed Neonates ,[object Object],[object Object],[object Object],[object Object]

Buprenorphine ,[object Object],[object Object],Full Agonist Full Antagonist Heroin Methadone Morphine Naltrexone Naloxone Buprenorphine Nalmefene

Case Reports and Open-Label Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Randomized Controlled Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Setting: Center for Addiction & Pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object]

Criteria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Primary Outcome Measures Infant ,[object Object],[object Object]

Selected Secondary Outcome Measures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Patient Flow Number screened 1490 Not Qualify Initially 1433 Qualify and sign consent 57 Randomized 30 Buprenorphine 15 Methadone 15 Buprenorphine 9 Methadone 11

Induction ,[object Object],[object Object],[object Object]

Induction Adapted from Jones,H.E. et al., In press. Drug and Alcohol Dependence

Maternal Outcome Drug Use During Pregnancy opioid 15.6 16.7 cocaine 11.2 15.2 amphetamine 0.0 0.0 barbiturates 0.0 0.0 benzodiazepine 0.4 2.5 THC 7.5 0.0 Methadone N=11 Buprenorphine N=9 % + Urine Samples

Maternal Characteristics % African-American 63.6 88.9 Gestation (weeks) 23.6 22.8 Education (yrs) 10.0 10.3 % Employed 0.0 0.0 Age (yrs) 30.3 30.0 Smoked Cigarettes 81.8 77.8 Methadone N=11 Buprenorphine N=9

Maternal Outcomes Days in Treatment 99.9 115.6 Prenatal care visits 3.4 3.6 LOS mom 2.2 2.2 C section % 9.1 11.1 Tox. + delivery (mom)% 9.1 0.0 Normal presentation % 100 100 Preterm birth % 9.1 0.0 Gestational age delivery 38.8 38.8 Ave. dose at delivery (mg) 79.1 18.7 Methadone N=11 Buprenorphine N=9

Birth Outcomes Methadone N=11 Buprenorphine N=9 deliveries (10 babies) * data safety monitoring board recommended removing twin data from these variables % Treated for NAS 45.5 20.0 Morphine Drops 93.1 23.6 Birth Weight (gm)* 3001.8 3530.4 LOS baby 8.1 6.8 % NICU treatment 18.0 10.0 APGAR 1 8.3 8.1 APGAR 5 8.9 8.7 Length (cm)* 49.6 52.8 Head Cir. (cm)* 33.2 34.9

Limitations of Study ,[object Object],[object Object],[object Object],[object Object]

Conclusions ,[object Object],[object Object],[object Object],[object Object]

Bottom Line ,[object Object],[object Object],[object Object]

Future Directions ,[object Object],[object Object],[object Object],[object Object]

Treating Pregnant Opioid Dependent Women: Examining Buprenorphine and Methadone

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Treating Pregnant Opioid Dependent Women: Examining Buprenorphine and Methadone