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Maintenance agonist treatments for opiate-dependent pregnant women

  1. Silvia Minozzi1,*,
  2. Laura Amato1,
  3. Cristina Bellisario2,
  4. Marica Ferri3,
  5. Marina Davoli1

Editorial Group: Cochrane Drugs and Alcohol Group

Published Online: 23 DEC 2013

Assessed as up-to-date: 7 OCT 2013

DOI: 10.1002/14651858.CD006318.pub3

How to Cite

Minozzi S, Amato L, Bellisario C, Ferri M, Davoli M. Maintenance agonist treatments for opiate-dependent pregnant women. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006318. DOI: 10.1002/14651858.CD006318.pub3.

Author Information

  1. 1

    Lazio Regional Health Service, Department of Epidemiology, Rome, Italy

  2. 2

    AO Città della Salute e della Scienza di Torino Via San Francesco da Paola 31, CPO Piemonte, Dipartimento Interaziendale di Prevenzione Secondaria dei Tumori S.C. Epidemiologia dei Tumori, Torino, Italy

  3. 3

    European Monitoring Centre for Drugs and Drug Addiction, Interventions, Best Practice and Scientific Partners, Lisbon, Portugal

*Silvia Minozzi, Department of Epidemiology, Lazio Regional Health Service, Via di Santa Costanza, 53, Rome, 00198, Italy.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 23 DEC 2013



References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Fischer 1999 {published data only}
Fischer 2006 {published data only}
Jones 2005 {published data only}
  • Jones HE, Johnson RE, Jasinski DR, O'Grady KE, Chisholm CA, Choo RE, et al. Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug and Alcohol Dependence 2005;79(1):1-10.
MOTHER Study {published data only}
  • Chisolm MS, Fitzsimons H, Leoutsakos JM, Acquavita SP, Heil SH, Wilson-Murphy M, et al. A comparison of cigarette smoking profiles in opioid-dependent pregnant patients receiving methadone or buprenorphine. Nicotine Tobacco Research 2013;15(7):1297-304.
  • Coyle MG, Salisbury AL, Lester BM, Jones HE, Lin H, Graf-Rohrmeister K, et al. Neonatal neurobehavior effects following buprenorphine versus methadone exposure. Addiction 2012;107(Suppl 1):63-73.
  • Gaalema DE, Scott TL, Heil SH, Coyle MG, Kaltenbach K, Badger GJ, et al. Differences in the profile of neonatal abstinence syndrome signs in methadone- versus buprenorphine-exposed neonates. Addiction 2012;107(Suppl 1):53-62.
  • Holbrook AM, Baxter JK, Jones HE, Heil SH, Coyle MG, Martin PR, et al. Infections and obstetric outcomes in opioid-dependent pregnant women maintained on methadone or buprenorphine. Addiction 2012;107(Suppl 1):83-90.
  • Jansson LM, Dipietro JA, Velez M, Elko A, Williams E, Milio L, et al. Fetal neurobehavioral effects of exposure to methadone or buprenorphine. Neurotoxicology and Teratology 2011;33(2):240-3.
  • Jones HE, Fischer G, Heil SH, Kaltenbach K, Martin PR, Coyle MG, et al. Maternal Opioid Treatment: Human Experimental Research (MOTHER)--approach, issues and lessons learned. Addiction 2012;107(Suppl 1):28-35.
  • Jones HE, Johnson RE, Jasinski DR, Tuten M, Milio L. Dosing pre to postpartum with either buprenorphine or methadone. Proceedings of the 69th Annual Scientific Meeting of the College on Problems of Drug Dependence. Quebec City, Canada, 2007:16-21.
  • Jones HE, Johnson RE, O'Grady KE, Jasinski DR, Tuten M, Milio L. Dosing adjustments in postpartum patients maintained on buprenorphine or methadone. Journal of Addiction Medicine 2008;2(2):103-7.
  • Jones HE, Kaltenbach K, Heil SH, Stine SM, Coyle MG, Arria AM, et al. Neonatal abstinence syndrome after methadone or buprenorphine exposure. New England Journal of Medicine 2010;363:2320-31.
  • Unger A, Jagsch R, Bäwert A, Winklbaur B, Rohrmeister K, Martin PR, et al. Are male neonates more vulnerable to neonatal abstinence syndrome than female neonates?. Gender Medicine 2011;8(6):355-64.
  • Wilson-Murphy MM, Chisolm MS, Leoutsakos JS, Kaltenbach K, Heil SH, Martin PR. Treatment completion in opioid-dependent pregnant patients randomised to agonist treatment: the role of intravenous drug use. Proceedings of the 73rd Annual Scientific Meeting of the College on Problems of Drug Dependence. 2011:195, Abstract no: 778.
  • Winklbaur-Hausknost B, Jagsch R, Graf-Rohrmeister K, Unger A, Baewert A, Langer M, et al. Lessons learned from a comparison of evidence-based research in pregnant opioid-dependent women. Human Psychopharmacology 2013;28(1):15-24.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
Bandstra 2012 {published data only}
Bell 2007 {published data only}
  • Bell J, Zador D. Dihydrocodeine as effective as methadone for maintenance of treatment for opiate dependence?. Evidence Based Mental Health 2007;10(3):88.
Binder 2008 {published data only}
  • Binder T, Vavrinkova B. Prospective randomised comparative study of the effect of buprenorphine, methadone and heroin on the course of pregnancy, birthweight of newborns, early postpartum adaptation and course of the neonatal abstinence syndrome (NAS) in women followed up in the outpatient department. Neuro Endocrinology Letters 2008;29(1):80-6.
Carroll 1995 {published data only}
  • Carroll KM, Chang G, Behr H, Clinton B, Kosten TR. Improving treatment outcome in pregnant, methadone-maintained women. American Journal on Addictions 1995;4(1):56-9.
Dawe 2007 {published data only}
  • Dawe S, Harnett P. Reducing potential for child abuse among methadone-maintained parents: results from a randomized controlled trial. Journal of Substance Abuse Treatment 2007;32(4):381-90.
Ebner 2007 {published data only}
  • Ebner N, Rohrmeister K, Winklbaur B, Baewert A, Jagsch R, Peternell A, et al. Management of neonatal abstinence syndrome in neonates born to opioid maintained women. Drug and Alcohol Dependence 2007;87:131-8.
Fisher 1998 {published data only}
  • Fisher G, Etzersdorfer P, Eder H, Jagsch R, Langer M, Weninger M. Buprenorphine maintenance in pregnant opiate addicts. European Addiction Research 1998;1:32-6.
Gordon 2004 {published data only}
  • Gordon AL, Stacey H, Pearson V, Haslam RR, Lopatko OV, White JM. Buprenorphine and methadone in pregnancy: effects on the mother and fetus/neonate. Sixty-Sixth Annual Scientific Meeting of the College on Problems of Drug Dependence. 2004.
Hulse 2004 {published data only}
  • Hulse GK, O'Neil G, Arnold-Reed DE. Methadone maintenance vs. implantable naltrexone treatment in the pregnant heroin user. International Journal of Gynaecology & Obstetrics 2004;85(2):170-1.
Jackson 2004 {published data only}
  • Jackson L, Ting A, Mckay S, Galea P, Skeoch C. A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome. Archives of Disease in Childhood. Fetal and Neonatal Edition 2004;89:300-4.
Jones 2008 {published data only}
  • Jones HE, Martin PR, Heil SH, Kaltenbach K, Selby P, Coyle MG, et al. Treatment of opioid-dependent pregnant women: clinical and research issues. Journal of Substance Abuse Treatment 2008;35(3):245-59.
Jones 2011 {published data only}
Keyser-Marcus 2002 {published data only}
  • Keyser-Marcus L, Miles D, Jansson L, Jones H, Svikis D. Perinatal opiate dependence: methadone and birth outcomes. Drug and Alcohol Dependence. 2002; Vol. 66 Suppl 1.
Lacroix 2011 {published data only}
  • Lacroix I, Berrebi A, Garipuy D, Schmitt L, Hammou Y, Chaumerliac C, et al. Buprenorphine versus methadone in pregnant opioid-dependent women: a prospective multicenter study. European Journal of Clinical Pharmacology 2011;67(10):1053-9.
Laken 1997 {published data only}
  • Laken MP, McComish JF, Ager J. Predictors of prenatal substance use and birth weight during outpatient treatment. Journal of Substance Abuse Treatment 1997;14(4):359-66.
Martin 2011 {published data only}
  • Martin PR. Opioid dependence during pregnancy: balancing risk versus benefit. Klinik Psikofarmakoloji Bülteni 2011;21:S35.
Newman 2009 {published data only}
Stine 2009 {published data only}
  • Stine SM, Heil SH, Kaltenbach K, Martin PR, Coyle MG, Fischer G, et al. Characteristics of opioid-using pregnant women who accept or refuse participation in a clinical trial: screening results from the MOTHER study. American Journal of Drug and Alcohol Abuse 2009;35(6):429-33.
Suchman 2007 {published data only}
  • Suchman NE, Rounsaville B, DeCoste C, Luthar S. Parental control, parental warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their school-aged and adolescent children. 2007 Journal of Substance Abuse Treatment;32(1):1-10.
Tuten 2012 {published data only}
  • Tuten M, Svikis DS, Keyser-Marcus L, O'Grady KE, Jones HE. Lessons learned from a randomized trial of fixed and escalating contingency management schedules in opioid-dependent pregnant women. American Journal of Drug and Alcohol Abuse 2012;38(4):286-92.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
AIHW 2011
  • Australian Institute of Health and Welfare. Drugs in Australia 2010: Tobacco, Alcohol and Other Drugs. Drug Statistics Series. Vol. 27 Cat. no. PHE 154, Canberra: AIHW, 2011.
Amato 2011
Brown 1998
Clark 2002
  • Clark NC, Lintzeris N, Gijsbers A, Whelan G, Dunlop A, Ritter A, et al. LAAM maintenance vs methadone maintenance for heroin dependence. Cochrane Database of Systematic Reviews 2002, Issue 2. [DOI: 10.1002/14651858.CD002210]
CSAT 2005
  • Center for Substance Abuse Treatment. Medication-assisted treatment for opioid addiction in opioid treatment programs. (Treatment Improvement Protocol Series 43). www.ncbi. 2005.
Dattel 1990
Dunlop 2003
  • Dunlop AJ, Panjari M, O'Sullivan H, Henschke P, Love V, et al. Clinical guidelines for the use of buprenorphine in pregnancy. Turning Point Alcohol and Drug Centre, Fitzroy, Australia 2003.
  • European Monitoring Centre for Drug & Drug Addiction (EMCDDA). European Drug Report 2013: Trend and Developments. Luxembourg: Publications Office of the European Union, 2013.
Faggiano 2003
  • Faggiano F, Vigna-Taglianti F, Versino E, Lemma P. Methadone maintenance at different dosages for opioid dependence. Cochrane Database of Systematic Reviews 2003, Issue 3. [DOI: 10.1002/14651858.CD002208]
Fajemirokun 2006
  • Fajemirokun-Odudeyi O, Sinha C, Tutty S, Pairaudeau P, Armstrong D, Phillips T, et al. Pregnancy outcome in women who use opiates. European Journal of Obstetrics, Gynecology, and Reproductive Biology 2006;126(2):170-5.
Ferri 2011
Finnegan 1992
  • Finnegan LP, Kaltenbach K. Neonatal abstinence syndrome. Primary Pediatric Care. 2nd Edition. St Louis: CV Mosby, 1992.
GRADE 2004
Guyatt 2008
  • Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924-6.
Guyatt 2011
  • Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines 1. Introduction-GRADE evidence profiles and summary of findings tables. Journal of Clinical Epidemiology 2011;64:383-94.
Higgins 2011
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from
Hulse 1997
Hulse 1998
Jarvis 1994
Johnson 2003
Jones 2012
Kaltenbach 1998
Lejuene 2006
  • Lejuene C, Simmat-Durand L, Gourarier L, Aubisson S for the Groupe d'Etudes Grossesses et Addictions (GEGA). Prospective multicenter observational study of 260 infants born to 259 opiate-dependent mothers on methadone or high-dose buprenorphine substitution. Drug and Alcohol Dependence 2006;82(3):250-7.
Ludlow 2004
Mattick 2009
Mattick 2008
Mayet 2004
Minozzi 2011
  • Minozzi S, Amato L, Vecchi S, Davoli M, Kirchmayer U, Verster A. Oral naltrexone maintenance treatment for opioid dependence. Cochrane Database of Systematic Reviews 2011, Issue 4. [DOI: 10.1002/14651858.CD001333.pub4]
Monitoring the Future 2012
  • Johnston LD, O’Malley PM, Bachman JG. Monitoring the Future. National Survey Results on Drug Use, 1975–2012. Vol. 1, Institute for Social Research, The University of Michigan, 2012.
NIH 1998
NSDUH 2010
  • National Survey on Drug Use and Health (NSDUH). 2011.
ONDCP 2013
  • Office of National Drug Control Policy (ONDCP). 2013.
Rayburn 2004
SAMHA 2012
  • Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-44, HHS. Vol. 12-4713, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012.
Schünemann 2006
  • Schünemann HJ, Jaeschke R, Cook D, Bria W, El-Solh A, Ernst A, et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. American Journal of Respiratory and Critical Care Medicine 2006;174:605-14.
UK Guidelines 2007
  • Department of Health (England), The Scottish Government, Welsh Assembly Government, Northern Ireland Executive. Drug Misuse and Dependence: UK Guidelines on Clinical Management. 2007.
UNODC 2007
  • United Nations Office on Drugs and Crime. 2007 World Drug Report. 2007.
Wang 1999
Winklbaur 2008