Background: Abundant evidence suggests that higher methadone doses are associated with diminished illicit opiate use. Moreover, evidence suggests that physiologic changes during pregnancy may necessitate increased methadone doses. Nevertheless, staff and patients alike have attitudinal barriers that may preclude dosage increases during pregnancy. We assessed whether practice patterns for pregnant women in a large methadone maintenance treatment program have changed in concert with evidence indicating that adequate dosing may improve pregnancy outcomes. Methods: We examined two cohorts of pregnant women enrolled in a methadone maintenance program, one from the 1980s (women who delivered 12/82 - 9/86) and one from 2000 (all women who delivered 2/4/00 - 11/9/00). Normally distributed data were tested using ANOVA; non-normally using Kruskall-Wallis. Results: Methadone-maintained women delivering in the 1980s (n=44) were younger (mean age 28) than in 2000 (n=23, mean age 35; p=<. 001). Equal proportions from the 1980s and 2000 cohorts entered treatment during pregnancy (26% and 27%, non-significant). The mean peak methadone dose was significantly higher in the 2000 cohort than in the earlier one (98 vs. 52 mg; p<0.001), as was the mean dose increase from conception to delivery (24 mg increase vs. 1 mg decrease; p<. 001). Conclusions: In keeping with secular trends among methadone patients generally, women delivering in 2000 received higher doses than those in the 1980s and were more likely to have had a dose increase during the course of the pregnancy. Future analyses will determine whether current practice improves secondary drug use and neonatal outcomes.
Learning Objectives: At the conclusion of this session, the participant will be able to: 1. Describe secular trends in methadone dosing. 2. Recognize efficacy of such trends. 3. Describe the population of child-bearing women within a large methadone system. 4. Describe changes in practice patterns for pregnant methadone-maintained women.
Keywords: Methadone Maintenance, Pregnancy
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Albert Einstein College of Medicine, Division of Substance Abuse
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment.