Guidelines for clinicians and staff involved in managing pregnant women, who are on buprenorphine maintenance programs for heroin dependence, have been published.

The guidelines are the first to be developed and rely on consensus between Australian and international drug and alcohol practitioners, obstetricians, midwives and neonatologists. The Royal Women’s Hospital Women’s Alcohol and Drug Service has provided obstetric and neonatal expertise in developing the guidelines.

Mary Panjari, who coordinated the project at Turning Point, says in Australia, unlike some other countries, buprenorphine is contraindicated in pregnancy due to lack of adequate information on the safety of the medication for pregnant women and their babies.

The current National Buprenorphine Clinical Guidelines recommend transferring a woman, already on a buprenorphine maintenance program for heroin dependence, to methadone when the pregnancy is diagnosed. However, some women may not be willing to change to methadone.
‘It is often a case of balancing risks. It is about treating the woman in a way that will reduce the risk of heroin use during pregnancy, which may be greater than the risks of buprenorphine maintenance for these women and their babies,�?Mary says.

Heroin use during pregnancy is associated with multiple problems including: an increased risk of miscarriage, premature labour, low birth weights, foetal distress, stillbirth, fatal and non-fatal overdose and exposure to blood-borne viruses.

Evidence on the safety of buprenorphine during pregnancy and lactation is now emerging and the guidelines will be regularly reviewed and modified depending on research outcomes.

Dr Adrian Dunlop, one of the authors of The Use of Buprenorphine in Pregnancy and Turning Point Medical Specialist, says too few studies have been done to comprehensively establish the safety, effectiveness and complications of the use of buprenorphine. Adrian says early work suggested that there may be a reduced incidence of neonatal withdrawal compared to that seen with methadone; however, more recent work suggests this may not be so.

The guidelines cover a range of topics including:

• objectives of opiate substitution maintenance during pregnancy
• the current level of knowledge of the safety of buprenorphine in pregnancy
• process of transfer from buprenorphine to methadone
• information and consent issues for women who decide to remain on buprenorphine after becoming pregnant
• management of buprenorphine use during pregnancy
• management of obstetric care
• use of buprenorphine post-partum

‘While we don’t yet know enough about the use of buprenorphine during pregnancy, it is important that women are given all the relevant information we have on opiate substitution in pregnancy,�?Adrian says.

Turning Point’s head of research Dr Alison Ritter says the guidelines, commissioned by the Department of Human Services, are important because they provide a standard by which to monitor both individual clinical management as well as standards of care across the system.
‘Buprenorphine is being used in Victoria for pregnant women and we want to make sure that these women receive the best possible care based on the latest research knowledge,�?Alison says.

The guidelines are available free to download at http://www.turningpoint.org.au/library/lib_online.htm

A printed copy of the report can be ordered at a cost of $22.00 via the catalogue order form (available for download online at http://www.turningpoint.org.au/library/lib_catalogue.html)

Source:

http://www.turningpoint.org.au/feature_stories/fs_bupe.htm