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Î Care for pregnant women with OUD should be co-managed by an
obstetrician and an addiction specialist physician.
• Release of information forms need to be completed to ensure communication
among health care providers.
Î Clinicians should be aware that the pharmacokinetics of methadone
are affected by pregnancy.
• With advancing gestational age, plasma levels of methadone progressively decrease
and clearance increases. Increased or split doses may be needed as pregnancy
progresses. After child birth, doses may need to be adjusted.
Î Buprenorphine monoproduct is a reasonable and recommended
alternative to methadone for pregnant women.
• While there is evidence of safety, there is insufficient evidence to recommend the
combination buprenorphine/naloxone formulation.
Î If a woman becomes pregnant while she is receiving naltrexone, it is
appropriate to discontinue the medication if the patient and doctor
agree that the risk of relapse is low.
• If the patient is highly concerned about relapse and wishes to continue naltrexone,
she should be informed about the risks of staying on naltrexone and provide her
consent for ongoing treatment.
• If the patient wishes to discontinue naltrexone but then reports relapse to opioid
use, it may be appropriate to consider treatment with methadone or treatment
with buprenorphine.
Î Naloxone is NOT recommended for use in pregnant women with OUD
except in situations of life threatening overdose.
Î Mothers receiving methadone and buprenorphine monoproduct for the
treatment of OUDs should be encouraged to breastfeed.
Individuals with Pain
Î For all patients with pain, it is important that the correct diagnosis be
made and that a target suitable for treatment is identified.
Î If pharmacological treatment is considered, nonnarcotic medications
such as acetaminophen and NSAIDs should be tried first.
Î Opioid agonists (methadone or buprenorphine) should be considered
for patients with active OUD who are not in treatment.
Î Pharmacotherapy in conjunction with psychosocial treatment should
be considered for patients with pain who have OUD.
Î Patients on methadone for the treatment of OUD will require doses of
opioids in addition to their regular daily dose of methadone to manage
acute pain.
