December 9, 2010

Buprenorphine Better than Methadone in Reducing Opioid Withdrawal Symptoms in Newborns

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Hendrée Jones
Hendrée Jones

RESEARCH TRIANGLE PARK, N.C.—In a comparative effectiveness trial, buprenorphine was found to be superior to methadone in treating opioid dependence in pregnant women and in reducing withdrawal symptoms in newborns, according to a recent study led by a researcher at RTI International.

The study, funded by the National Institute on Drug Abuse (NIDA), a component of the National Institutes of Health, was published today in The New England Journal of Medicine.

Methadone is currently the recommended treatment for opioid-addicted pregnant women and, when properly used, is considered relatively safe for the fetus. However, it is associated with a neonatal abstinence syndrome—a cluster of symptoms stemming from opioid withdrawal in the newborn—often requiring medical treatment and extended hospital stays.

Buprenorphine is a more recently approved medication for treating opioid addiction, but less is known about its effects in pregnant women and their babies. This study found that, compared to methadone, buprenorphine resulted in lower severity of NAS symptoms, thus requiring less medication and less time in the hospital for their babies.

"In addition to providing support for the viability of buprenorphine to treat pregnant women, we were able to closely examine the severity of neonatal abstinence syndrome following prenatal exposure to methadone or buprenorphine" said Hendree Jones, Ph.D., a senior researcher at RTI who was at Johns Hopkins University when she led the study. "We were pleased to be able to identify a medication that lessens the withdrawal distress to newborns, and gets them out of the hospital more quickly."

The research project, called The Maternal Opioid Treatment: Human Experimental Research (MOTHER), was one of the first to prospectively follow opioid-dependent pregnant women from enrollment until at least 28 days after giving birth. Women who volunteered for the study were addicted to opioids, such as heroin or prescription painkillers, with low rates of other illicit drug use so that the neonatal abstinence syndrome could be clearly attributable to the opioids. In all, the eight-site international study included 131 mothers and their newborns.

"Finding medications to help an addicted mother and her newborn is crucial for improving the public's health" said Dr. Nora D. Volkow, director of NIDA. "By comparing two effective medications for treating opioid addiction, this study will give health care providers and their patients vital information that will help them choose the treatment offering the greatest benefits."

Methadone maintenance treatment has been used for more than 40 years. When properly used, it can safely and effectively treat heroin addiction. However, in the United States, its use as a treatment for addiction is restricted to specialized opiate treatment programs. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin and other opiates and return to more stable and productive lives.

Buprenorphine is a newer medication, approved by the FDA in 2002, for the treatment of opioid addiction in non-pregnant patients. It has weaker opioid effects than methadone and is less likely to produce overdose. Buprenorphine also produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than do individuals who stop taking methadone. Buprenorphine can be prescribed to treat opioid addiction in the privacy of a certified physician's office.