Association of methadone dose with substance use and treatment retention in pregnant and postpartum women with opioid use disorder

摘要

Abstract Background In non-pregnant individuals being treated for opioid use disorder (OUD) with methadone, doses ≥ 60 mg per day are associated with improved treatment retention and decreased illicit opioid use. Although methadone remains the first line treatment for OUD in pregnant women, there are no studies replicating this finding in pregnancy. Methods We conducted a retrospective cohort study of 189 pregnant women treated with methadone for OUD from 2006 to 2013. Chart data collected included demographics, pregnancy dates, methadone doses, and urine drug screen (UDS) results. Results Treatment retention at delivery was significantly higher for subjects taking ≥ 60 mg of methadone (90.1% v. 74.1% p 0.005), as was treatment retention at 60 days postpartum (71.6% v. 37.0%, p 0.0001). Percent of UDS results negative for illicit substances during pregnancy was also significantly higher for subjects taking ≥ 60 mg (71.5% v. 58.0%, p 0.04). There was no significant difference in UDS results in the first 60 days postpartum (63.9% v. 68.1%). Generalized linear models showed a significant positive relationship between methadone dose and treatment retention at delivery (p 0.02) and at 60 days postpartum (p 0.004) as well as a significant positive relationship between length of time in treatment and treatment retention at delivery (p 0.04) and at 60 days postpartum (p 0.007). Maternal age and percent of negative UDS results were not predictive of treatment retention in either model and there was no significant interaction effect between methadone dose and percent negative UDS results. Conclusions In this cohort, women taking ≥ 60 mg of methadone during pregnancy were more likely to remain in treatment and to provide urine samples negative for illicit drugs. Multivariate modeling suggested a dose dependent response across the entire dose range, rather than a threshold effect at 60 mg. Highlights ? Pregnant women on ≥ 60 mg methadone had significantly higher treatment retention at delivery and 60 days postpartum ? Pregnant women on ≥ 60 mg methadone had significantly fewer illicit urine drug tests at delivery, but not 60 days postpartum ? There was a significant dose-dependent relationship between methadone dose and retention at delivery and 60 days postpartum