Box 4: Summary of retrospective case series describing methadone detoxification in pregnancy
ReferenceProtocolOutcomes at delivery
MaternalNeonatal
Maas et al. 199042
n = 58

  • Outpatient detoxification lasting 2–8 wk

  • Individualized taper of 0.2–1 mg of methadone daily

  • Abstinence: 17/58

  • MMT taper: 8/58

  • MMT taper with illicit drug use: 32/58

  • Lost to follow-up: 1/58

  • Fewer NAS symptoms, lower PTD rate, higher body weight, longer pregnancies among women who abstained, followed by women who underwent MMT, compared with women who continued to use heroin

Dashe et al. 199840
n = 34		Stabilization

  • Clonidine: mild withdrawal

  • Methadone: moderate to severe withdrawal

Taper

  • No more than 20% every 3 d

  • 3–39 d, median 12-d inpatient stay

  • Abstinence: 59%

  • MMT: 12%

  • Illicit drug use: 29%

  • NAS: 44% of infants showed symptoms, 15% required treatment

  • PTD: no deliveries before 36 wk

  • Stillbirth: none

Luty et al. 200343
n = 101

  • 21-d inpatient methadone taper

  • 51 women lost to follow-up

  • Complete records for 24 women and 22 infants

  • Abstinence: 1/24

  • MMT and opiate use: not documented

  • Rehabilitation program postpartum: none

  • NAS: Not documented

  • PTD: 7/22 infants for whom records were available

  • Stillbirth: None

Jones et al. 200844
n = 123		3-d methadone taper (n = 75)

  • Day 1, 20 mg; day 2, 10 mg; day 3, 10 mg

7-d methadone taper (n = 48)

  • Day 1, 30 mg; dose reduced by 5 mg each day thereafter

  • Abstinence: 47% (3-d taper) and 43% (7-d taper)

  • MMT: 11% (3-d taper) and 42% (7-d taper)

  • Illicit drug use: 53% (3-d taper) and 57% (7-d taper) vs. 23% in control group receiving MMT

  • No difference between case and control groups for NAS, low birth weight or APGAR scores

Stewart et al. 201341
n = 95		Stabilization

  • Methadone dose based on history of use and titrated up based on withdrawal symptoms

Taper

  • No more than 20% every 1–3 d

  • Abstinence: 56%

  • MMT: 18%

  • Illicit drug use: 44%

  • NAS: Lower Finnegan scores, shorter stays in hospital and less treatment

  • PTD: No difference

  • Stillbirth: 2 (mothers were actively using heroin)

  • Note: APGAR = appearance, pulse, grimace, activity, respiration; MMT = methadone maintenance therapy; NAS = neonatal abstinence syndrome; PTD = preterm delivery.