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Methadone substitution therapy of opioid use disorder during pregnancy

Neil S Seligman, MD
Vincenzo Berghella, MD
Section Editors
Lynn L Simpson, MD
Andrew J Saxon, MD
Deputy Editors
Vanessa A Barss, MD, FACOG
Richard Hermann, MD


Methadone is a synthetic opioid agonist used for medically supervised withdrawal and substitution treatment of opioid use disorder (heroin; diverted or misused, prescribed opioid analgesics or other morphine-like drugs), along with appropriate social and medical services. Methadone substitution therapy has many potential benefits during pregnancy and postpartum (table 1). Nevertheless, several barriers to methadone treatment exist, including lack of health insurance, incarceration, transportation and childcare needs, guilt about the effect of drugs on the fetus, and fear of legal consequences, including loss of custody of children.

This topic will review management of methadone substitution therapy in pregnant and postpartum women. The choice of methadone versus buprenorphine substitution therapy and management of buprenorphine substitution therapy are discussed separately. (See "Buprenorphine substitution therapy of opioid use disorder during pregnancy".)

Methadone is also an option for treatment of moderate to severe chronic pain during pregnancy when alternative treatment options are inadequate [1]; this indication is beyond the scope of this topic.


The two main approaches to treatment of opioid use disorder during pregnancy are opioid substitution therapy (with either methadone or buprenorphine) and opioid withdrawal followed by nondrug psychosocial treatment. (See "Psychosocial interventions for opioid use disorder", section on 'Approach to treatment'.)

Both methadone treatment and medically supervised opioid withdrawal involve substituting a prescribed opioid for illicit opioids. In opioid substitution therapy, the opioid is administered in doses sufficient to prevent symptoms of withdrawal and reduce or eliminate drug craving. In medical withdrawal, the opioid dose is gradually reduced to the lowest dose that prevents withdrawal symptoms and then reduced further until the drug can be discontinued. Maintenance psychosocial interventions, which follow opioid withdrawal, include addiction counseling, peer support groups, and/or structured, multi-modal approaches. (See "Psychosocial interventions for opioid use disorder", section on 'Psychosocial interventions'.)

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Literature review current through: Nov 2017. | This topic last updated: Sep 25, 2017.
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