Opioid Withdrawal During Pregnancy May Reduce Rates of Neonatal Abstinence Syndrome (NAS) [27E

Abstract

INTRODUCTION: The incidence of Neonatal Abstinence Syndrome (NAS) has risen dramatically in the United States (U.S) during the past decade paralleling the increase in pregnant patients with opioid dependence. Current U.S. Drug Enforcement Agency (DEA) policy does not support opioid withdrawal during pregnancy. DEA policy and the paucity of Licensed Narcotic Treatment Programs in the U.S. that accept Medicaid payment has led to limited options for opioid-dependent patients who request voluntary withdrawal during pregnancy. METHODS: This pilot study was designed to assess safety and efficacy of voluntary withdrawal using methadone. The study is a prospective cohort comparing patients who enrolled in methadone withdrawal to a cohort of patients who chose to remain in methadone maintenance. RESULTS: 31 pregnant patients were identified with opioid dependency at our institution from 2014 to present (ICDM 10). 15 patients were in the withdrawal program and 16 chose to remain in maintenance. 4 of those in the withdrawal program remain pregnant. One was lost to follow up. The rate of NAS in the methadone maintenance cohort was 33% (5/15). The rate of NAS in the successful withdrawal group was 0% (6/6). The rate of NAS in the failed withdrawal group was 100% (3/3). There was one pregnancy loss in each group. There was a spontaneous abortion in the maintenance group and one perinatal death at 26 weeks in the withdrawal group. CONCLUSION: Successful, supervised opioid withdrawal during pregnancy may reduce rates of Neonatal Abstinence Syndrome as compared to opioid maintenance.