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Dosing Adjustments in Postpartum Patients Maintained on Buprenorphine or Methadone

Jones, Hendrée E. PhD; Johnson, Rolley E. PharmD; O’Grady, Kevin E. PhD; Jasinski, Donald R. MD; Tuten, Michelle MSW, LCSW-C; Milio, Lorraine MD

Journal of Addiction Medicine: June 2008 - Volume 2 - Issue 2 - p 103-107
doi: 10.1097/ADM.0b013e31815ca2c6
Original Article

Scant scientific attention has been given to examining the need for agonist medication dose changes in the postpartum period. Study objectives were: 1) to determine the need for medication dose adjustments in participants stabilized on buprenorphine or methadone 3 weeks before and 4 weeks after delivery, and 2) to evaluate the need for methadone dose adjustments during the first 7 days in participants transferred from buprenorphine to methadone at 5 weeks postpartum. Participants were opioid-dependent pregnant women who had completed a randomized, double-blind, double-dummy, flexible dosing comparison of buprenorphine to methadone. Participants received a stable dose of methadone (N = 10) or buprenorphine (N = 8) before and 4 weeks after delivery. Buprenorphine-maintained participants were transferred to methadone at 5 weeks postpartum. There were no significant differences predelivery and/or postdelivery between the buprenorphine and methadone conditions in the mean ratings of dose adequacy, “liking,” “hooked,” and “craving” of heroin or cocaine. Patient response to the conversion from buprenorphine to methadone seems variable. Buprenorphine-maintained participants required dose changes postpartum only after they transferred to methadone. Regardless of type of medication, postpartum patients should be monitored for signs of overmedication.

From the Departments of Psychiatry and Behavioral Sciences (HEJ, REJ, MT), Medicine (DRJ), and Obstetrics and Gynecology (LM), Johns Hopkins University School of Medicine, Baltimore, MD; Reckitt Benckiser Pharmaceuticals Inc. (REJ), Richmond, VA; and the Department of Psychology (KEO), University of Maryland, College Park, College Park, MD.

Received August 3, 2007; revised September 26, 2007; accepted September 30, 2007.

Send correspondence and reprint requests to Dr. Hendrée E. Jones, Johns Hopkins Bayview Medical Campus, D-3-East, 4940 Eastern Avenue, Baltimore, MD 21224. e-mail: hejones@jhmi.edu

This work was supported by grants DA R01 12220, DA R01 015764 from the National Institute on Drug Abuse and M01RR-02719 from the General Clinical Research Centers Program of the National Center of Research Resources, National Institutes of Health.

© 2008 American Society of Addiction Medicine