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Fwd: hello and question From: R. Daniel Braun (rd.braun@gmail.com) Tue May 31 19:04:57 2005 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: Need referral -Physician/Midwife in France" Previous message: jane.wines@telus.net: "qualifications" I forwarded this question to my Colleague, Jim Nocon, who runs our substance abuse clinic at our county hospital. Here is his response ---------- Forwarded message ---------- Date: May 31, 2005 1:55 PM Subject: Re: hello and question To: "R. Daniel Braun" <rd.braun@gmail.com> Dan, Current thinking is that weaning from methadone during pregnancy poses a risk to fetus if mother goes through abrupt withdrawal. Here's the options: 1. stay on 10 mg per day, this is a very low dose methadone does not harm baby and at this does, may have no effect. methadone does not cause IUGR neonatal abstinence syndrome (NAS) (withdrawal) is dose related and newborn may not need treatment at this dose expect minimal to no observable withdrawal for a term baby safe to breast feed while on methadone even after baby goes through withdrawal if she stops breast feeding while on methadone - baby may go through withdrawal (unlikely at this dose) 2. reduce methadone dosage ante partum - recommend 1 mg per week. she may be able to be methadone free by delivery time may take up to 10 days to excrete methadone metabolite baby may still have mild NAS 3. wean from methadone post partum - recommend 1-2.5 mg per week safe to breast feed 4. stay on methadone until after delivery and then switch to buprenorphine maintenance Personal Experience: I have observed patients on 70 - 80 mg per day successfully wean to 50 mg. day, but none were able to get below 50 mg/day plateau. One patient with twins delivered at 32 weeks and she was on 15 mg of methadone per day - she breast fed and newborns did not appear to have NAS even though p[preterm jjn -----Original Message----- *From:* R. Daniel Braun [mailto:rd.braun@gmail.com] *Sent:* Tuesday, May 31, 2005 12:23 PM *To:* Nocon, James J. *Subject:* Fwd: hello and question Jim would you likje to give a short answer to this that I can post on our list? Dan ---------- Forwarded message ---------- From: Rachel Hedin <nprapha@hotmail.com> Date: May 31, 2005 11:58 AM Subject: hello and question To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net> Hi. I'm a family practice nurse practitioner working in women's health...currently also beginning studies for a second master's degree to get my CNM. We have a 32 y/o client at my clinic who just moved from out of state. She is 26 weeks pregnant (G2 P1, had a c. section for FTP in Sept 2004 and is due again Sept 2005) She has struggled with drug addiction in the past, but has been sober for 8 years and currently is maintained on 10 mg of methadone a day. She would like to discontinue the methadone completely but was advised by her previous provider to wait until after the birth. There are no methadone clinics/addictionists nearby for us to refer to. We found out legally that we CAN continue to prescribe for her during her pregnancy, so the group has asked that we do some research into what the best action plan is. Mom is very motivated to get off the methadone as she wants to prevent IUGR, withdrawl syndromes postnatally, etc. If anybody has any experience with this...or suggestions about how to taper mom off (and when) as well as any risks/pitfalls to look out for, I'd appreciate the input. FWIW mom is in a very structured living environment with lots of emotional support right now as she has voluntarily joined a live-in religious program for unwed moms. Thanks! Rachel RN MSN -- R. Daniel Braun Kinky for Governor -- R. Daniel Braun Kinky for Governor Next message: R. Daniel Braun: "Re: Need referral -Physician/Midwife in France" Previous message: jane.wines@telus.net: "qualifications"

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