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Heroin Addiction and Related Clinical Problems: 2015, 17, 6 (pages: 31 - 40)

Effects of treatment diversification on neonatal abstinence syndrome:1999-2002 vs. 2009-2012

Unger A., Brandt L., Fischberger S., Moser L., Fischer G., and Jagsch R.

Summary: Background: In the past ten years opioid maintenance treatment options for pregnancy have diversified, yet the incidence of neonatal abstinence syndrome (NAS) has increased. Aim: To compare NAS treatment outcomes in light of maternal treatment diversification of two cohorts treated in the same specialized facility monitored between 1999-2002 and 2009-2012. Methods: Maternal and neonatal outcomes of 42 mother-neonate dyads monitored 1999-2002 [n = 36 (86%) maintained on methadone (MET), mean daily dose at delivery 68.46 mg; n = 6 (14%) on buprenorphine (BUP), 8.80 mg/day] were compared with 68 opioid dependent mother-neonate dyads monitored between 2009-2012 [n = 39 (57.4%) maintained on MET, mean daily dose at delivery 58.62 mg; n = 29 (42.6%) on BUP, 9.60 mg/day] in terms of maternal demographic and treatment variables, birth outcome parameters and NAS outcomes. Results: The main finding was a reduction of pre-term birth rates (19% in the 1999-2002 cohort compared with 7% in the 2009-2012 cohort, p = 0.065) and the length of neonatal hospital stay (1999-2002: 27 days vs. 2009-2012: 18 days, p = 0.030). The average duration of gestation increased from 37.9 weeks (1999-2002) to 39.0 weeks (2009-2012) (p = 0.085). In addition, for methadone-maintained women, a significant reduction of concomitant substance use was shown over the investigated time frame. Conclusions: These results support the diversification of treatment options for pregnant opioid-dependent women in order to improve treatment efficacy for mother and child, with the potential to reduce the high costs of care in this population.