A comparison of buprenorphine and methadone in the reduction of neonatal abstinence syndrome

Abstract

OVERVIEW OF TOPIC: Neonatal abstinence syndrome (NAS) is a condition caused when a new-born withdraws from certain drugs exposed to in the womb before birth. NAS is often caused when pregnant women are exposed to opioids during pregnancy. Buprenorphine and Methadone are the two main medications used for opioid dependence as a maintenance therapy, although Methadone is known to be the first line treatment. The aim of this literature review is to compare the two medications in order to evaluate the effectiveness and safeness of Buprenorphine in reducing Neonatal Abstinence syndrome in infants. RESEARCH QUESTION: ‘Is Buprenorphine compared to Methadone safer in reducing neonatal abstinence syndrome, in pregnant women with opioid dependence?’ PICO ELEMENTS: Population – pregnant women with opioid dependence, Intervention – Buprenorphine, Comparison – Methadone, Outcome – which is safer and reduces neonatal abstinence syndrome. SEARCH METHODS: A literature search was conducted by using the UoM online resources mainly HyDi, EBSCO, PubMed and also Google Scholar. Different keywords were elicited to facilitate the search for relevant studies. The aim was to choose studies ranked top on the hierarchy of evidence. The inclusion criteria mainly included both medications being listed, Buprenorphine and Methadone, and including Neonatal Abstinence Syndrome. Peer reviewed articles published in the last 15 years and English language were also included in the inclusion criteria. Whilst the search excluded articles which did not focused on both medications, Buprenorphine and Methadone, and also articles which were not English language. The outcome of the search resulted in a total of 8 studies, which included 1 metanalysis, 1 comprehensive study, 2 randomized controlled studies, 1 non-randomised comparison study, 2 cohort studies, and 1 retrospective study. The reason that different studies were chosen was due to the limitation in articles which fitted in both the inclusion and exclusion criteria. Nevertheless, the studies used were ranked from middle to top in the hierarchy of evidence pyramid, and none were found ranking in the bottom. RESULTS: The results of all appraised studies were more or less similar were 6 articles agreed that Buprenorphine is safer in reducing neonatal abstinence syndrome, whilst also offering advantages of less treatment needed such as Morphine, and eventually leading to shorter length of stay in hospital. Only 2 articles agreed that there were no significant differences in the reduction of neonatal abstinence syndrome with both medications. CONCLUSION: Overall the results have showed that Buprenorphine can be a safer and effective option in reducing neonatal abstinence syndrome and therefore can be used as first line treatment in opioid dependence for pregnant women. RECOMMENDATIONS: As discussed in Practice, Management, education, and research, it is shown that further research is needed both internationally and mostly nationally, with a larger scale population.