title: Managing opioid dependence in pregnancy -- a general practice perspective.
abstract: BACKGROUND
  Managing opioid dependence in pregnant women is a complex and potentially challenging task. Drug-dependent women may be difficult to engage in antenatal care and opioid substitution requires careful dose titration. Pregnancy, however, can be an opportune time to effect behaviour change, and supporting an opioid-dependent woman through pregnancy can be a rewarding clinical experience.
  
  
  OBJECTIVE
  This article provides an overview of treatment principles for managing opioid dependence in pregnancy, and reviews current treatment guidelines for use of opioid-substitution therapy in pregnant women.
  
  
  CONCLUSIONS
  The management of opioid dependence during pregnancy requires holistic and comprehensive assessment and referral to specialist services is often appropriate. Specific issues that may need to be addressed include decision-making regarding the choice of opioid-substitution therapy and the potential for neonatal abstinence syndrome in the newborn. General practitioners are often well placed to support and coordinate care of their opioid-dependent pregnant patients.
authors.affiliation: MBBS, MPsych, FRANZCP, is an Addiction Psychiatry Registrar, Turning Point Alcohol and Drug Centre, Eastern Health, Melbourne, Victoria.
authors.forename: Shalini
authors.initials: S
authors.lastname: Arunogiri
authors.forename: Lea
authors.initials: L
authors.lastname: Foo
authors.forename: Matthew
authors.initials: M
authors.lastname: Frei
authors.forename: Dan I
authors.initials: DI
authors.lastname: Lubman
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D058006:General Practice / Q000379:methods*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009357:Neonatal Abstinence Syndrome / Q000209:etiology; D058850:Opiate Substitution Treatment / Q000009:adverse effects; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology / Q000517:prevention & control*; D011295:Prenatal Care; D055815:Young Adult
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone