Access

You are not currently logged in.

Access your personal account or get JSTOR access through your library or other institution:

login

Log in to your personal account or through your institution.

Medication-Assisted Treatment for Pregnant Women: A Systematic Review of the Evidence and Implications for Social Work Practice

Amber M. Holbrook and Viba H. Nguyen
Journal of the Society for Social Work and Research
Vol. 6, No. 1 (Spring 2015), pp. 1-19
DOI: 10.1086/680232
Stable URL: http://www.jstor.org/stable/10.1086/680232
Page Count: 19
  • Download PDF
  • Add to My Lists
  • Cite this Item
We're having trouble loading this content. Download PDF instead.

Abstract

AbstractEvidence-based practice with pregnant clients who are opioid-dependent can be especially challenging because pregnant women are rarely included in clinical trials. The paper synthesizes systematic reviews on the outcomes of medication-assisted treatment for opioid dependent pregnant women and compares the effectiveness of methadone and buprenorphine. We explore evidence on maternal and neonatal outcomes, the safety of breastfeeding, and discuss the implications for social work practice. Searches were conducted in 6 databases. Ten reviews met the inclusion criteria. Results suggest medication-assisted treatment with either methadone or buprenorphine are equally effective in reducing maternal substance use, although methadone may offer slightly higher treatment retention rates when flexible dosing is implemented. Physical parameters and Apgar scores at birth show no significant differences in neonates exposed to methadone versus buprenorphine. Rates of treatment for neonatal abstinence syndrome also do not differ. However, when treatment is required burprenorphine may produce a shorter duration of withdrawal. Data on long-term developmental outcomes following in-utero exposure to opioid maintenance medications is inconclusive. Results suggest that there is minimal transmission of either methadone or buprenorphine to the neonate in breast milk. Conclusions are limited by missing data on broader psychosocial and maternal health outcomes. Evidence on long-term developmental outcomes for neonates is also confounded by prenatal drug exposure and environmental factors. Social workers engage with opioid-dependent pregnant women in many settings and can play an important role in ensuring access to treatment, and in addressing misconceptions around medication-assisted treatment for pregnant women with family members, peer supports, and other health care providers.

Notes and References

This item contains 57 references.

References
  • ['*denotes article included in the review']
  • ['Alto, W. A., & O’Connor, A. B. (2011). Management of women treated with buprenorphine during pregnancy. American Journal of Obstetrics and Gynecology, 205(4), 302–308. http://dx.doi.org/10.1016/j.ajog.2011.04.001']
  • ['*Bandstra, E. S., Morrow, C. E., Mansoor, E., & Accornero, V. H. (2010). Prenatal drug exposure: Infant and toddler outcomes. Journal of Addictive Diseases, 29(2): 245–258. http://dx.doi.org/10.1080/10550881003684871']
  • ['Bart, G. (2012). Maintenance medication for opiate addiction: The foundation of recovery. Journal of Addictive Diseases, 31, 207–225. http://dx.doi.org/10.1080/10550887.2012.694598']
  • ['Behnke, M., Smith, V.C., Committee on Substance Abuse, & Committee on Fetus and Newborn. (2013). Prenatal substance abuse: Short- and long-term effects on the exposed fetus. Pediatrics, 131, e1009-e10024. http://dx.doi.org/10.1542/peds.2012-3931']
  • ['Carrieri, M. P., Amass, L., Lucas, G. M., Vlahov, D., Wodak, A., & Woody, G. E. (2006). Buprenorphine use: The international experience. Clinical Infectious Diseases, 43, S197–S215. http://dx.doi.org/10.1086/508184']
  • ['Center for Substance Abuse Treatment. (2005). Medication-assisted treatment for opioid addiction in opioid treatment programs. Treatment Improvement Protocol (TIP) Series 43 (HHS Publication No. SMA 12-4214). (Rev. ed.). Rockville, MD: Substance Abuse and Mental Health Services Administration. http://dx.doi.org/10.1037/e715712007-001']
  • ['Centers for Disease Control and Prevention. (2011). Vital signs: Overdoses of prescription opioid pain relievers—United States, 1998–2008. Morbidity and Mortality Weekly Report, 60, 1487–1492. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm']
  • ['*Cleary, B. J, Donnelly, J., Strawbridge, J., Gallagher, P. J., Fahey, T., Clarke, M., & Murphy, D. J. (2010). Methadone dose and neonatal abstinence syndrome—Systematic review and meta-analysis. Addiction, 105, 2071–2084. http://dx.doi.org/10.1111/j.1360-0443.2010.03120.x']
  • ['Degenhardt, L., Bucello, C., Mathers, B., Briegleb, C., Ali, H., Hickman, M., & McLaren, J. (2011). Mortality among regular or dependent users of heroin and other opioids: A systematic review and meta-analysis of cohort studies. Addiction, 106, 32–51. http://dx.doi.org/10.1111/j.1360-0443.2010.03140.x']
  • ['Faggiano, F., Vigna-Taglianti, F., Versino, E., & Lemma, P. (2003). Methadone maintenance at different dosages for opioid dependence. Cochrane Database of Systematic Reviews, 3, CD002208. http://dx.doi.org/10.1002/14651858.CD002208']
  • ['Fajemirokun-Odudeyi, O., Sinha, C., Tutty, S., Pairaudeau, P., Armstrong, D., Phillips, T., & Lindow, S. W. (2006). Pregnancy outcome in women who use opiates. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 126, 170–175. http://dx.doi.org/10.1016/j.ejogrb.2005.08.010']
  • ['Fitzsimmons, H. E., Tuten, M., Vaidya, J., & Jones, H. E. (2007). Mood disorders affect drug treatment success of drug-dependent pregnant women. Journal of Substance Abuse Treatment, 32, 19–25. http://dx.doi.org/10.1016/j.jsat.2006.06.015']
  • ['Glatstein, M. M., Garcia-Bournissen, F., Finkelstein, Y., & Koren, G. (2008). Methadone exposure during lactation. Canadian Family Physician, 54, 1689–1690.']
  • ['Goddard, P. (2003). Changing attitudes towards harm reduction among treatment professionals: A report from the American Midwest. International Journal of Drug Policy, 14, 257–260. http://dx.doi.org/10.1016/s0955-3959(03)00075-6']
  • ['*Goodman, D. (2011). Buprenorphine for the treatment of perinatal opioid dependence: Pharmacology and implications for antepartum, intrapartum, and postpartum care. Journal of Midwifery and Women’s Health, 56, 240–247. http://dx.doi.org/10.1111/j.15422011.2011.00049.x']
  • ['Higgins, J.P.T., & Green, S. (Eds.). (2011). Cochrane handbook for systematic reviews of interventions version 5.1.0. Cochrane Collaboration. Retrieved from http://www.cochrane-handbook.org']
  • ['Hilton, T. C. (2012). Breastfeeding considerations of opioid dependent mothers and infants. MCN: American Journal of Maternal/Child Nursing, 37, 236–240. http://dx.doi.org/10.1097/NMC.0b013e318251056c']
  • ['Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., … Lau, J. (2007). Breastfeeding and maternal and infant health outcomes in developed countries (AHRQ Publication No. 07-E007). Evidence Report/Technology Assessment, 153, 1–186. Retrieved from http://archive.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdf']
  • ['Jackson, T. R. (2002). Treatment practice and research issues in improving opioid treatment outcomes. Science and Practice Perspectives, 1(1), 22–28. http://dx.doi.org/10.1151/spp021122']
  • ['*Jansson, L. M., Velez, M., & Harrow, C. (2004). Methadone maintenance and lactation: A review of the literature and current management guidelines. Journal of Human Lactation, 20(1), 62–71. http://dx.doi.org/10.1177/0890334403261027']
  • ['Jansson, L. M., Velez, M., & Harrow, C. (2009). The opioid-exposed newborn: Assessment and pharmacologic management. Journal of Opioid Management, 5, 47–55. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2729086/']
  • ['Jarvis, M. A., & Schnoll, S. H. (1994). Methadone treatment during pregnancy. Journal of Psychoactive Drugs, 26, 155–161. http://dx.doi.org/10.1080/02791072.1994.10472263']
  • ['*Johnson, R. E., Jones, H. E., & Fischer, G. (2003). Use of buprenorphine in pregnancy: Patient management and effects on the neonate. Drug and Alcohol Dependence, 70, S87–S101. http://dx.doi.org/10.1016/s0376-8716(03)00062-0']
  • ['Jones, H. E., Kaltenbach, K., Heil, S. H., Stine, S. M., Coyle, M. G., Arria, A. M., … Fischer, G. (2010). Neonatal abstinence syndrome after methadone or buprenorphine exposure. New England Journal of Medicine, 363, 2320–2331. http://dx.doi.org/10.1056/nejmoa1005359']
  • ['Kaltenbach, K., Holbrook, A. M., Coyle, M. G., Heil, S. H., Salisbury, A. L., Stine, S.M., . . . Jones, H. E. (2012). Predicting treatment for neonatal abstinence syndrome in infants born to women maintained on opioid agonist medication. Addiction, 107, 45–52. http://dx.doi.org/10.1111/j.1360-0443.2012.04038.x']
  • ['*Konijnenberg, C., & Melinder, A. (2011). Prenatal exposure to methadone and buprenorphine: A review of the potential effects on cognitive development. Child Neuropsychology, 17, 495–519. http://dx.doi.org/10.1080/09297049.2011.553591']
  • ['Lattimore, K. A., Donn, S. M., Kaciroti, N., Kemper, A. R., Neal, C.R. Jr., Vazquez, D. M. (2005). Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: A meta-analysis. Journal of Perinatology, 25, 595–604. http://dx.doi.org/10.1038/sj.jp.7211352']
  • ['Ludlow, J. P., Evans, S. F., & Hulse, G. (2004). Obstetric and perinatal outcomes in pregnancies associated with illicit substances. Australian and New Zealand Journal of Obstetrics and Gynaecology, 44, 301–306. http://dx.doi.org/10.1111/j.1479-828x.2004.00221.x']
  • ['Mathers, B. M., Degenhardt, L., Phillips, B., Wiessing, L., Hickman, M., Strathdee, S.A., … Mattick, R. P. for the 2007 Reference Group to the UN on HIV and Injecting Drug Use. (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. Lancet, 372, 1733–1745. http://dx.doi.org/10.1016/S0140-6736(08)61311-2']
  • ['Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews, 8(3), CD002209.pub2. http://dx.doi.org/10.1002/14651858.cd002209.pub2']
  • ['Mattick, R. P., Breen, C., Kimber, J., & Davoli, M. (2014). Buprenorphine maintenance versus placebo versus methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2: CD002207. http://dx.doi.org/10.1002/14651858.CD002207.pub4']
  • ['Mayet, S., Farrell, M., Ferri, M., Amato, L., & Davoli, M. (2005). Psychosocial treatment for opiate abuse and dependence. Cochrane Database of Systematic Reviews, 25(1), CD004330. http://dx.doi.org/10.1002/14651858.cd004330.pub2']
  • ['*Minozzi, S., Amato, L., Vecchi, S., & Davoli, M. (2013). Maintenance agonist treatments for opiate dependent pregnant women. Cochrane Database of Systematic Reviews, 12, CD006318. http://dx.doi.org/10.1002/14651858.cd006318.pub3']
  • ['Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & The Prisma Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Medicine, 6(7), e1000097. http://dx.doi.org/10.1371/journal.pmed.1000097']
  • ['*Muller, M. J., Lange, M., Paul, T., & Seelinger, S. (2011). Breast feeding during methadon and buprenorphin therapy. Klinische Padiatrie, 223(7), 408–413. http://dx.doi.org/10.1055/s-0031-1283193']
  • ['National Association of Social Workers. (2014). Social work profession: General fact sheet. Retrieved from http://www.socialworkers.org/pressroom/features/general/profession.asp']
  • ['Nelson, P. K., Mathers, B. M., Cowie, B., Hagan, H., Des Jarlais, D., Horyniak, D., & Degenhardt, L. (2011). Global epidemiology of hepatitis B and hepatitis C in people who inject drugs: Results of systematic reviews. Lancet, 378, 571–583. http://dx.doi.org/10.1016/S0140-6736(11)61097-0']
  • ['Nunn, A., Zaller, N., Dickman, S., Trimbur, C., Nijhawan, A., & Rich, J. A. (2009). Methadone and buprenorphine prescribing and referral practices in US prison systems: Results from a nationwide survey. Drug and Alcohol Dependence, 105, 83–88. http://dx.doi.org/10.1016/j.drugalcdep.2009.06.015']
  • ['Park, E. M., Meltzer-Brody, S., & Suzuki, J. (2012). Evaluation and management of opioid dependence in pregnancy. Psychosomatics, 53, 424–432. http://dx.doi.org/10.1016/j.psym.2012.04.003']
  • ['Pritham, U. A., Troese, M., & Stetson, A. (2007). Methadone and buprenorphine treatment during pregnancy: What are the effects on infants? Nursing for Women’s Health, 11, 558–567. http://dx.doi.org/10.1111/j.1751-486X.2007.00243.x']
  • ['Rich, J. D., Boutwell, A. E., Shield, D. C., Key, R. G., McKenzie, M., Clarke, J. G., & Friedmann, P. D. ( 2005). Attitudes and practices regarding the use of methadone in US stateand federal prisons. Journal of Urban Health, 82, 411–419. http://dx.doi.org/10.1093/jurban/jti072']
  • ['Rich, J. D., McKenzie, M., Shield, D. C., Wolf, F. A., Key, R. G., Poshkus, M., & Clarke, J. (2005). Linkage with methadone treatment upon release from incarceration: A promising opportunity. Journal of Addictive Diseases, 24, 49–59. http://dx.doi.org/10.1300/J069v24n03_04']
  • ['Roberts, S. (2011). Complex calculations: How drug use during pregnancy becomes a barrier to prenatal care. Maternal and Child Health Journal, 15, 333–341. http://dx.doi.org/10.1007/s10995-010-0594-7']
  • ['Ruger, J. P., & Lazar, C. M. (2012). Economic evaluation of drug abuse treatment and HIV prevention programs in pregnant women: A systematic review. Addictive Behaviors, 37, 1–10. http://dx.doi.org/doi:10.1016/j.addbeh.2011.07.042']
  • ['Shainker, S. A., Saia, K., & Lee-Parritz, A. (2012). Opioid addiction in pregnancy. Obstetrical and Gynecological Survey, 67, 817–825. http://dx.doi.org/10.1097/OGX.0b013e3182788e8c']
  • ['Substance Abuse and Mental Health Services Administration. (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-44, HHS Publication No. SMA 12-4713). Rockville, MD. Retrieved from http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresults2012.pdf']
  • ['Substance Abuse and Mental Health Services Administration. (2013a). Report to Congress on the nation’s substance abuse and mental health workforce issues (Pub. ID PEP13-RTC-BHWORK). Rockville, MD: Author. Retrieved from http://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf']
  • ['Substance Abuse and Mental Health Services Administration. (2013b). The N-SSATS report: Trends in the use of methadone and buprenorphine at substance abuse treatment facilities: 2003 to 2011. Rockville, MD: Author. Retrieved from http://www.samhsa.gov/data/']
  • ['Terplan, M., & Lui, S. (2007). Psychosocial interventions for pregnant women in outpatient illicit drug treatment compared to other interventions. Cochrane Database of Systematic Reviews, 4, CD006037. http://dx.doi.org/10.1002/14651858.CD006037.pub2.']
  • ['*Thajam, D., Atkinson, D.E., Sibley, C. P., & Lavender, T. (2010). Is neonatal abstinence syndrome related to the amount of opiate used? Journal of Obstetric, Gynecologic, and Neonatal Nursing, 39, 503–509. http://dx.doi.org/10.1111/j.1552-6909.2010.01174.x']
  • ['Welle-Strand, G. K., Skurtveit, S., Jones, H. E., Waal, H., Bakstad, B., Bjarko, L., & Ravndal, E. (2013). Neonatal outcomes following in utero exposure to methadone or buprenorphine: A national cohort study of opioid-agonist treatment of pregnant women in Norway from 1996-2009. Drug and Alcohol Dependence, 127, 200–206. http://dx.doi.org/10.1016/j.drugalcdep.2012.07.001']
  • ['Wilcox, A. J. (2001). On the importance—and the unimportance—of birthweight. International Journal of Epidemiology, 30, 1233–1241. http://dx.doi.org/10.1093/ije/30.6.1233']
  • ['*Winklbaur, B., Kopf, N., Ebner, N., Jung, E., Thau, K., & Fischer, G. (2008). Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: A knowledge synthesis for better treatment for women and neonates. Addiction, 103, 1429–1440. http://dx.doi.org/10.1111/j.1360-0443.2008.02283.x']
  • ['Winklbaur, B., Baewert, A., Jagsch, R., Rohrmeister, K., Metz, V., Aeschbach Jachmann, C., … Fischer, G. (2009). Association between prenatal tobacco exposure and outcome of neonates born to opioid-maintained mothers. Implications for treatment. European Addiction Research, 15, 150–156. http://dx.doi.org/10.1159/000216466']
  • ['Wolf, D.A.P.S., Maguin, E., Ramsey, A., & Stringfellow, E. (2014). Measuring attitudes toward empirically supported treatment in real-world addiction services. Journal of Social Work Practice in the Addictions, 14, 141–154. http://dx.doi.org/10.1080/1533256X.2014.902717']
  • ['World Health Organization. (2009). Global health risks: Mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: Author. Retrieved from http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf']