Recommendations for opioid agonist pharmacotherapy and against medically assisted withdrawal were based upon early reports that associated withdrawal with maternal relapse and fetal demise. Data from recent case series have called these recommendations into question. Although these data do not support an association between medically assisted withdrawal and fetal demise, relapse remains a significant clinical concern with reported rates ranging from 17% to 96% (average 48%). Given the high loss to follow-up in these studies, the actual relapse rate is likely even greater. Furthermore, while medically assisted withdrawal is being proposed as a public health strategy to reduce neonatal abstinence syndrome (NAS), current data do not support a reduction in NAS with medically assisted withdrawal relative to opioid agonist pharmacotherapy. Overall, the data do not support either benefit of medically assisted withdrawal or equivalence to opioid agonist pharmacotherapy for the maternal-newborn dyad. Medically assisted withdrawal increases the risk of maternal relapse and poor treatment engagement and does not improve newborn health. Treatment of chronic maternal disease, including opioid agonist disorder, should be directed toward optimal long-term outcome.
UNC Horizons and Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC (HEJ); Departments of Psychiatry and Obstetrics and Gynecology, School of Medicine, Johns Hopkins University (HEJ); Behavioral Health System, Baltimore, MD (MT); Department of Obstetrics, Gynecology & Reproductive Sciences, University of Vermont, Burlington, VT (MM).
Send correspondence and reprint requests to Hendrée E. Jones, PhD, UNC Horizons, 127 Kingston Drive, Chapel Hill, NC 27514. E-mail: Hendree_Jones@med.unc.edu
Received 16 November, 2016
Accepted 11 December, 2016
The authors report no conflicts of interest.