Effective methadone dose does not harm newborns

Main Category: Public Health
Article Date: 22 Sep 2003 - 0:00 PDT


Treating heroin-addicted pregnant women with the most effective dose of methadone does not increase their infants' symptoms of withdrawal after they are born, new study findings suggest.

Instead, methadone appears to reduce risks to both mother and infant by preventing illicit drug use.

Methadone is often substituted for heroin and other opiates when patients are treated for their addiction. When the methadone dose is high enough, it blocks the effects of heroin and reduces addicts' craving for the drug.

Many physicians believe that methadone doses should be kept no higher than 20 milligrams per day when women are pregnant, lead investigator Dr. Vincenzo Berghella told Reuters Health. But effective doses for pregnant women range from 50 to 200 mg daily.

Therefore, his research group, based at Jefferson Medical College of Thomas Jefferson University in Philadelphia, examined the records of 100 mother-newborn pairs treated in their comprehensive program for drug-addicted pregnant women. Methadone doses ranged from 20 to 200 mg per day, they note in their article in the American Journal of Obstetrics and Gynecology.

Their study differed from previous research, they point out, because it examines higher average doses and the last dose prior to delivery. They also scored the newborns' withdrawal problems using an objective measure of clinical signs and symptoms, called the Newborn Abstinence Score (NAS).

Birth weight, highest NAS, presence of neonatal withdrawal, and average duration of treatment for withdrawal did not differ significantly between the higher doses and lower doses of methadone.

'I was happily surprised when our data confirmed that using an effective dose is best for both the women and their babies,' Berghella said.

He added that prior research demonstrated that methadone has no long-term effects on the fetus, 'just short-term withdrawal,' which occurred in 60 percent of the babies.

'Effective maintenance prevents drug hunger and craving and blocks the euphoric effect of illicit drugs,' he noted. As a result, the fetus is not exposed to erratic maternal opioid levels, protecting it from repeated episodes of withdrawal.

Furthermore, he said, 'by preventing drug-seeking behavior, women are less likely to engage in prostitution or other behaviors that increase their risk of HIV, hepatitis infection, and other sexually transmitted diseases.'

He advises heroin-addicted women to check into a program that not only helps them with their symptoms of withdrawal, but also addresses psychological and social issues. The program at Jefferson Medical College 'even helps women find housing, stay away from an abusive partner, and provides basic preventive medical care.

'That way, people can become clean and can stay clean,' Berghella concluded.

SOURCE: American Journal of Obstetrics and Gynecology, August 2003.

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