Several models have been studied for treatment of opioid dependence during pregnancy. The purpose of our study is to examine maternal and neonatal outcomes following a methadone taper for medication-assisted withdrawal (MAW) for opioid dependent pregnant women.METHODS:
A retrospective chart review of pregnant women undergoing inpatient MAW using a methadone taper and delivering at the study institution was performed. At our institution, methadone taper is performed over approximately six days beginning with a total of 30mg of methadone on Day 1. As needed doses are available to the patient, however this does not affect the overall taper length. “Success” of MAW was defined as appropriate urine drug screen (UDS) on admission to Labor and Delivery (LDR).RESULTS:
Among study participants (n=32) 47% had an appropriate UDS at admission to LDR. Among those who were successful vs those who were not, mean length of stay (6.20 vs. 4.18days p=0.0150) and the incidence of opiate maintenance at time of delivery (93% vs. 23%, p<.0001) were significantly different. Differences in neonatal outcomes included number of neonates treated for neonatal abstinence syndrome (33% vs. 47% p=0.4905) and mean maximum morphine dose (0.05 vs. 0.08mg p=0.3985), however none were significant.CONCLUSION:
MAW (as performed at our institution) results in a less than 50% success rate. Success rates are higher when the taper is performed more slowly and when maintenance therapy is utilized. Therefore, if MAW is preferred by the patient, completion of the entire taper should be encouraged and maintenance therapy should be discussed following MAW completion.