Buprenorphine safer than methadone during pregnancy for opioid-use disorder

Treating treat opioid-use disorder with buprenorphine during pregnancy is showing better outcomes for newborns than methadone. Researchers reported in the NEJM that buprenorphine was associated with lower risks of preterm birth, small size for gestational age, low birth weight and neonatal abstinence syndrome than methadone. The issue is of importance because opioid use disorder rates among pregnant people has been increasing the past 20 years. In the U.S. “as of 2017, approximately 8.2 per 1,000 deliveries were estimated to be affected by opioid use disorder nationwide,” researchers wrote. Rates are even higher among the population by Medicaid where an estimated 14.6 per 1,000 deliveries are affected.” Buprenorphine or methadone are both standard of care, but they have important differences. “Methadone is a full agonist with high intrinsic activity at mu-opioid receptors, whereas buprenorphine is a high-affinity partial agonist with low intrinsic activity.” Importantly, methadone is administered during in-person visits to federally regulated opioid treatment programs. However, buprenorphine can be prescribed and patients can administer the medication themselves. The cohort study was conducted using U.S. Medicaid databases, and included 2,548,372 pregnancies that ended in live births from the years 2000 through 2018. In early pregnancy, a total of 10,704 pregnancies had exposure to buprenorphine and 4,387 to methadone. In late pregnancy, 11,272 were exposed to buprenorphine and 5,056 to methadone. In the 30 days before delivery these numbers were 9,976 and 4,597 respectively. Analyses showed that neonatal abstinence syndrome occurred in 52.0% of the infants with buprenorphine exposure in the 30 days before delivery, and in 69.2% of those exposed to methadone. Read: 'High-risk' businesses in Ontario must have opioid antidote kits and training by June Other measures also showed differences. Preterm birth occurred in 14.4% of infants exposed to buprenorphine in early pregnancy, compared to 24.9% of those exposed to methadone. Small size for gestational age occurred in 12.1% and 15.3% of infants respectively; and low birth weight in 8.3% and 14.9%. No associations were found when it came the use of either drug and cesarean section and severe maternal complications. The study concluded that “The use of buprenorphine in pregnancy was associated with a lower risk of adverse neonatal outcomes than methadone use; however, the risk of adverse maternal outcomes was similar among persons who received buprenorphine and those who received methadone.” Read: Researchers say alternative to methadone shows promise for those addicted to opioids.

Buprenorphine safer than methadone during pregnancy for opioid-use disorder

Register for free access or login.

Related Topics