Comparison of methadone and slow-release morphine maintenance in pregnant addicts.
OBJECTIVE
To investigate whether the neonatal abstinence syndrome (NAS) is different in children born to women maintained on slow-release morphine, compared with those maintained on methadone, and to compare additional drug consumption in these groups of women.


METHODS
An open, randomized trial was conducted in an established clinic. Forty-eight pregnant women who presented to the clinic as opiate or polysubstance abusers were enrolled and maintained on either methadone (24 women) or slow-release morphine (24 women) up to and following delivery. The programme included psychosocial therapy and support for their opiate-addicted partners.


METHODS
Standard urinalysis methods were used to measure consumption of cocaine and benzodiazepines during pregnancy. Injection sites were monitored to indicate additional opiate use. NAS was measured according to Finnegan score and the amount of phenobarbiturates prescribed to alleviate the symptoms.


RESULTS
No difference was found in the number of days that NAS was experienced by neonates born to methadone or morphine maintained mothers (mean = 16 and 21 days, respectively). All children were born healthy and no serious complications arose. Fewer benzodiazepines (p < 0.05) and fewer additional opiates (p < 0.05) were consumed by the morphine-maintained women compared with those who took methadone, but no difference was seen in cocaine consumption. Nicotine consumption was reduced significantly in both groups during pregnancy (p < 0.02).


CONCLUSIONS
Both methadone and morphine are suitable maintenance agents for pregnant opiate addicts. Maintenance agents that result in a less prolonged NAS should be studied in further trials.
Department of General Psychiatry, University Hospital of Vienna, Austria. gabriele.fischer@akh-wien.ac.at
G
G
Fischer
R
R
Jagsch
H
H
Eder
W
W
Gombas
P
P
Etzersdorfer
K
K
Schmidl-Mohl
C
C
Schatten
M
M
Weninger
H N
HN
Aschauer
D000293:Adolescent; D000328:Adult; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008691:Methadone / Q000009:adverse effects*; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D009294:Narcotics / Q000009:adverse effects*; D009357:Neonatal Abstinence Syndrome / Q000209:etiology*; D011247:Pregnancy; D019966:Substance-Related Disorders / Q000534:rehabilitation*
D003692:Delayed-Action Preparations; D009294:Narcotics; D009020:Morphine; D008691:Methadone