title: Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol.
abstract: OBJECTIVE
  To compare the length of wean and abstinence severity in neonatal and pediatric patients with neonatal abstinence syndrome or iatrogenic opioid dependence treated with a pharmacist-managed, methadone-based protocol compared with physician-managed patients treated with either methadone or dilute tincture of opium (DTO).
  
  
  METHODS
  This was a prospective, single-centered, interventional evaluation of 54 pharmacist-managed patients versus 53 retrospective, physician-managed patients. Wean duration and severity of neonatal abstinence syndrome were compared between groups using the Student t test.
  
  
  RESULTS
  Significantly shorter wean duration in in utero-exposed pharmacist-managed patients compared with patients on physician-managed DTO (11.7 days vs 24.2 days, p < 0.001), but not compared with patients on physician-managed methadone (11.7 days vs 47 days, p = 0.101). No statistically significant difference was seen in wean duration in iatrogenic-exposed pharmacist-managed patients compared with patients on either physician-managed DTO or methadone (8.69 days vs 14 days, p = 0.096) and (8.69 days vs 9.82 days, p = 0.34), respectively. There were significantly fewer abstinence scores >12 in pharmacist-managed patients versus physician-managed DTO, but not physician-managed methadone (2.05 vs 17.3, p = 0.008 and 2.05 vs 74.3, p = 0.119, respectively). Significantly fewer abstinence scores ≥8 × 3 consecutively were seen in pharmacist-managed patients compared with patients on either physician-managed DTO or methadone (2.89 vs 11.9, p = 0.01 and 2.89 vs 24, p < 0.001, respectively).
  
  
  CONCLUSIONS
  Use of a pharmacist-managed, methadone-based weaning protocol standardizes patient care and has the potential to decrease abstinence severity and shorten duration of wean versus physician-managed patients exposed to opioids in utero. Additionally, a methadone wean of 10% to 20% per day was well tolerated in both neonatal and pediatric patients.
authors.affiliation: Pharmacy, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado.
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Johnson
authors.affiliation: Pharmacy, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado.
authors.forename: David R
authors.initials: DR
authors.lastname: Nash
authors.affiliation: Neonatology, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado ; Pediatrix Medical Group, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado.
authors.forename: Mary R
authors.initials: MR
authors.lastname: Laird
authors.affiliation: Neonatology, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado ; Pediatrix Medical Group, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Kiley
authors.affiliation: United States Air Force, Colorado Springs, Colorado.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Martinez
keywords: fentanyl; methadone; neonatal abstinence syndrome; opioid; protocol; withdrawal