Is MAT with buprenorphine or methadone in a pregnant patient the standard of care?
Yes. Methadone and buprenorphine are both evidence based treatments for women with OUD who are pregnant. The developing fetus is at risk if the mother is in withdrawal. Maintained on MAT most women with OUD have a healthy pregnancy. It is not medically appropriate to detox a pregnant patient on buprenorphine or methadone during the pregnancy.
Does MAT treatment always result in neonatal abstinence syndrome (NAS)?
No. The incidents of NAS in pregnant women maintained on methadone or buprenorphine is approximately 60-80%. There is no correlation between the main dose of methadone or buprenorphine and the incidents or severity of NAS. Recent evidence has shown that neonates born to mothers on buprenorphine have a less severe NAS, require less medication treatment and have a shorter length of stay in the NICU.
Is it appropriate to treat adolescents with MAT? If so what age is recommended to start? What MAT is used?
Yes. MAT in adolescents is appropriate. Buprenorphine is currently the treatment of choice in adolescents. Naltrexone and methadone are reasonable options as well. In all ages, but this group in particular, it is also critical they engage in groups and other behavioral health treatments.
