Buprenorphine aids infants of opioid-dependent women

Buprenorphine can be used as an alternative to methadone for treating opioid-dependent pregnant women and seems to mitigate neonatal abstinence syndrome (NAS) in their infants, a recent study reports.

Researchers from the Johns Hopkins University School of Medicine in Baltimore randomized 175 pregnant women with opioid dependency to receive buprenorphine (a partial μ-opioid antagonist) or methadone (a full μ-opioid antagonist). Of 131 neonates whose mothers were followed to the end of pregnancy, the 58 exposed to buprenorphine required significantly less morphine (mean dose, 1.1 mg vs 10.4 mg; P<.0091) and had significantly shorter hospital stays (10.0 days vs 17.5 days; P<.0091) and duration of treatment (4.1 days vs 9.9 days; P<.003125) for NAS than the 73 infants exposed to methadone. The study found no significant differences in neonatal or maternal adverse events between the buprenorphine and methadone groups.

“Although there were no significant differences in overall rates of NAS among infants exposed to buprenorphine and those exposed to methadone, the benefits of buprenorphine in reducing the severity of NAS among neonates with this complication suggest that it should be considered a first-line treatment option in pregnancy,” the authors write.

However, “clinicians should take into account the possibility of reduced adherence and the ceiling effect” of buprenorphine at maximum doses relative to methadone. Thirty-three percent of the women in the buprenorphine group discontinued treatment compared with 18% of the women in the methadone group. The reasons for discontinuation are unknown.

Several authors of the study, which was published in The New England Journal of Medicine (2010;363:2320-2331), disclosed financial relationships with pharmaceutical companies, including Reckitt Benckiser, which supplied the researchers with buprenorphine and placebo products.