Clinical guidelines for the use of buprenorphine in pregnancy

Table of contents
EXECUTIVE SUMMARY…………………………………………………………………………..1
INTRODUCTION ……………………………………………………………………………………..2
Medico-legal issues …………………………………………………………………………………………………………………….. 2
OPIOID DEPENDENCE AND PREGNANCY……………………………………………….3
Opioid use during pregnancy ………………………………………………………………………………………………………. 3
Pregnancy outcomes…………………………………………………………………………………………………………………. 3
Neonatal abstinence …………………………………………………………………………………………………………………. 5
OPIOID SUBSTITUTION IN PREGNANCY …………………………………………………6
Objectives of opioid substitution ………………………………………………………………………………………………….. 6
Opioid substitution during pregnancy………………………………………………………………………………………….. 6
Objectives of opioid substitution in pregnancy……………………………………………………………………………… 7
Management of opioid substitution during pregnancy and perinatally ………………………………………….. 8
Assessment of pregnant women………………………………………………………………………………………………….. 8
Maintenance treatment ………………………………………………………………………………………………………………. 8
Breastfeeding ………………………………………………………………………………………………………………………….. 9
Other management approaches for the treatment of heroin dependence during pregnancy………….. 10
BUPRENORPHINE ………………………………………………………………………………..11
Registration and listing of buprenorphine ………………………………………………………………………………….. 11
Literature summary: clinical studies of buprenorphine and pregnancy……………………………………….. 13
Concerns regarding the use of buprenorphine in pregnancy ……………………………………………………….. 17
Monitoring of women for pregnancy while on buprenorphine programs……………………………………… 19
Use of buprenorphine in pregnancy……………………………………………………………………………………………. 20
Transfer from buprenorphine to methadone………………………………………………………………………………. 22
Management with buprenorphine during pregnancy ………………………………………………………………….. 23
Management of dependence……………………………………………………………………………………………………… 23
Management of opiate dependence with buprenorphine……………………………………………………………. 23
Notification of buprenorphine pregnancy ……………………………………………………………………………….. 23
Frequency of review………………………………………………………………………………………………………… 23
Management of heroin use ……………………………………………………………………………………………….. 24
Dose adjustments……………………………………………………………………………………………………………. 24
Monitoring…………………………………………………………………………………………………………………….. 24
Dose reductions or detoxification during pregnancy…………………………………………………………….. 24
Turing Point Alcohol and Drug Centre and The Royal Women’s Hospital
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Frequency of dosing ………………………………………………………………………………………………………… 24
Use of other substances ……………………………………………………………………………………………………. 24
Dispensing Issues ……………………………………………………………………………………………………………. 25
Poor progress on buprenorphine ……………………………………………………………………………………………. 25
Direct transfer from methadone to buprenorphine……………………………………………………………………… 26
Induction onto buprenorphine after diagnosis of pregnancy ……………………………………………………….. 26
Management of obstetric care ……………………………………………………………………………………………………. 27
Management of ante-natal care …………………………………………………………………………………………………. 27
Frequency of review ……………………………………………………………………………………………………………. 27
Multidisciplinary team approach …………………………………………………………………………………………… 27
Monitoring of pregnancy ……………………………………………………………………………………………………… 27
Timing of delivery ………………………………………………………………………………………………………………. 27
Care in labour………………………………………………………………………………………………………………………… 28
Induction …………………………………………………………………………………………………………………………… 28
Analgesia during labour and caesarean section ……………………………………………………………………….. 28
During labour ………………………………………………………………………………………………………………… 28
Postpartum…………………………………………………………………………………………………………………….. 29
Caesarean section ……………………………………………………………………………………………………………. 29
Use of buprenorphine post-partum…………………………………………………………………………………………….. 29
Management of neonatal care ……………………………………………………………………………………………………. 30
Neonatal Withdrawal Syndrome ……………………………………………………………………………………………….. 30
Breast feeding and buprenorphine……………………………………………………………………………………………… 32
Recommendations ………………………………………………………………………………………………………………….. 32
Prescribing requirements………………………………………………………………………………………………………….. 33
APPENDIXES………………………………………………………………………………………..34
APPENDIX 1: PATIENT CONSENT FORM FOR BUPRENORPHINE
TREATMENT DURING PREGNANCY / BREASTFEEDING ………………………..35
APPENDIX 2: LETTER FROM OBSTETRIC SERVICE TO GENERAL
PRACTITIONERS…………………………………………………………………………………..36
APPENDIX 3: NEONATAL ABSTINENCE SCORE – FINNEGAN SCORE…….36
APPENDIX 4: ISSUES FOR CLINICAL DISCUSSION………………………………..38
APPENDIX 5: CONTACT PHONE NUMBERS …………………………………………..39
REFERENCES ………………………………………………………………………………………41

Please read more:CTG_Bup_Pregnancy_060104

Methadone Vs. Subutex/ Suboxone!

Very few studies have considered heroin users’ views on substitute prescribing, in
particular with regards to subutex. The aim of this study was to conduct detailed
qualitative analysis, using the Grounded theory approach, on heroin users’ views on
substitute prescribing, paying specific attention to methadone and subutex. Semistructured
interviews were conducted with nine subjects recruited from an
abstinence-based, structured day care treatment program. All of the subjects were
either currently on a subutex prescribing program, or had remained abstinent from
illicit substances following the completion of a subutex treatment program. Five major
themes emerged from the analysis. These were reasons for obtaining a methadone
prescription, experiences with methadone programs, views on methadone, views on
subutex and views on an ideal opioid treatment program. Most of the findings were
supported by previous qualitative studies such as that of Neale (1999a) and Fischer
and colleagues (2002). However, there does appear to be some discrepancies
between qualitative and quantitative research with regards to consumer satisfaction
of methadone, in comparison to subutex, as a substitute drug. This study clearly
highlights the need for further research into users’ views on substitute prescribing,
with emphasis being placed on qualitative research considering users’ experiences
with subutex.

Read the full File: methadoneversussubutex kopie