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Heroin Addiction and Related Clinical Problems: 2024, 26, 67

Rapid transition from high-dose methadone to buprenorphine-naloxone and long-acting buprenorphine in a perinatal patient with Opioid Use Disorder: A case report

Sara Kreim, Shanlea Gordon, Nicole Carter, Melissa Dreyer, James Ketch, and Charissa J. Patricelli

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2024-67

Summary: Background: Methadone or buprenorphine/naloxone (Suboxone) is the standard of care for pregnant individuals with opioid use disorder (OUD). However, there is a lack of research and clinical practice guidelines addressing transitions from methadone to buprenorphine/naloxone and other opioid agonist therapies, including long-acting buprenorphine perinatally. Case summary: We present the case of a pregnant 27-year-old woman from Vancouver, Canada, with a nine-year history of OUD. She presented to the hospital at 34+3 gestation with preeclampsia. The patient received minimal antenatal care and reported the use of fentanyl (inhaled) throughout the pregnancy and methamphetamine (inhaled) during the first trimester. She was admitted to the Families in Recovery (FIR) unit at the British Columbia Women’s Hospital and Health Centre, stabilised on methadone and hydromorphone and delivered vaginally at 36+4 gestation. She expressed a strong desire to transition to long-acting buprenorphine, and at 15 days postpartum, she underwent a rapid transition from methadone to buprenorphine/naloxone and long-acting buprenorphine. During the transition, acetaminophen, clonidine, dimenhydrinate, ibuprofen, lorazepam, and non-pharmacological strategies were used to manage withdrawal symptoms. Once on a stable dose of the new medication regimen, she was discharged in custody of her child to supportive housing with community health and social support in collaboration with child and family services. Discussion: This case demonstrates the feasibility of rapid transition from methadone to buprenorphine/naloxone and long-acting buprenorphine perinatally in the context of a highly motivated patient. Further research is required to establish evidence-based clinical practice guidelines for supporting patients in transitioning between different opioid agonist therapies perinatally.

Keywords: Buprenorphine, Methadone, Perinatal Care, Substance-Related Disorders