Risks of methadone use as substitute therapy for opioid addiction during pregnancy and use of clonidine as a plausible alternative


Aurora Saint Luke’s Medical Center


Detoxification of opioid addiction during the pregnancy has been avoided since 1970 after some reports showed untoward outcome including stillbirth and acute narcotic withdrawal syndrome in neonates. It was recommended at that time to avoid detoxification until more data was collected and improved monitoring of fetal homeostasis became available. Since then methadone has been used for both maintenance and detoxification for opiate addiction while scant work was done to find alternative therapies even though improved technology for monitor fetal homeostasis has made more alternatives to therapy available. Methadone use during pregnancy carries real risks in terms of psychological and behavior development of the neonate and may have neuro-adaptation leading to changes in neurotransmitter function that may lead to abnormal adolescent behavior as the child grows. We suggest that detoxification should again be considered in place of opioid due to improved monitoring of fetal and maternal homeostasis, especially for women using less than 75 mg/day of methadone. For others, clonidine should be considered as an alternative to methadone.

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