|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
FW: Methadone in pregnancy amendedFrom: Braun, R. Daniel (rbraun@iupui.edu)Fri Oct 31 04:28:27 2003
I sent the comments about this issue to Jim Nocon who is the Director of our Substance abuse Clinic here at the Wishard Memorial Hospital. He is also widely known in the field of Substance abuse. The following are his comments for your perusal. They are forwarded with his permission. Dan Dan, the observations are partly true and it depends on the methadone maint (MM) clinic. Local Clinic A tends to be like the one mentioned - they do not want to decrease methadone levels during pregnancy. On the other hand, they are very supportive and cooperative in the management of our mutual patients. In contrast, Local Clinic B is a private MM clinic and we have successfully decreased methadone levels in selected (motivated) patients. There is an article in the Canadian addiction medicine literature that describes sudden IUFD in attempting to decrease methadone levels, especially in the 3rd trimester. However, the IUFD appears to have occurred in detoxification where the methadone dose was decreased rapidly. In my experience, methadone can be decreased 2-5 mg per week (the lower level the better) but most patients get symptoms of withdrawal at about 22 hours when they get below 50 mg. For the large majority of patients, levels of 70-90 mg are the norm and withdrawal symptoms do not occur until about 26-28 hours from last dose. There is a sub group of patients who experience withdrawal symptoms at 22 hours as the pregnancy progresses. Thus, they require an increase in the methadone dose. There may be an antagonism between estrogen and methadone at the mu receptors but this is poorly understood. However, it does account for the observation that clinics increase the dose in some pregnant patients. In Europe, pregnant narcotic addicts are managed with buprenorphine rather than methadone. Buprenorphine can be rapidly detoxed with minimal withdrawal symptoms. This would allow for a baby to be virtually narcotic free by the time of the delivery. Likewise newborns on buprenorphine can be rapidly detoxed - 2-3 days in contrast to 3-4 weeks with methadone. Although the FDA approved the use of Buprenorphine in the US, it has yet to approve it use in pregnancy. James J Nocon, M.D. -----Original Message----- From: Braun, R. Daniel Sent: Thursday, October 30, 2003 6:15 AM To: Nocon, James J. Subject: FW: Methadone in pregnancy Jim, Any thoughts about this? Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Dr. Ainsworth Sent: Wednesday, October 29, 2003 7:46 PM To: Multiple recipients of list OB-GYN-L Subject: Methadone in pregnancy I've seen more patients in the last couple of years on methadone maintenance than I recall in previous years. My impression is that the methadone clinics only incentive is to increase the number of patients they treat and increase the amount of methadone they dispense. These patients are told by the clinic that they cannot stop methadone during pregnancy because they will miscarry. Rather than attempting to detox patients during the second trimester or taper them down to a workable level of 20-40 mg by the third trimester, most of these patients have been increased to 120 mg or greater. It is frustrating because the clinic gives no feedback and I've even had the experience of patients not even informing me until late in their pregnancies that they are on methadone - to "avoid stigmatization." I've tried to enter into a dialogue with the physician who is in charge of the clinic, I've sent several faxed notes about specific patients as well as my general concerns but get no response. If you read the literature on methadone in pregnancy, this is far from ideal! How is it working in other's experience and areas?
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Fri May 2 04:37:22 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.