Opioid dependent babies benefit from buprenorphine when suffering from neonatal abstinence syndrome

Opioid dependent babies benefit from buprenorphine when suffering from neonatal abstinence syndrome

Newborns suffering from neonatal abstinence syndrome do better when treated with sublingual buprenorphine than the usual oral morphine, says new study

There’s been a lot of attention on the so-called “opioid epidemic” in America recently, and media coverage regularly echoes the call for wider application of medication assisted treatment (MAT), especially buprenorphine, which helps reduce opioid withdrawal symptoms while coming off heroin or opioid painkillers, for example. Stepping down the daily dose of buprenorphine, which is used routinely at Novus for this purpose, results in a faster and more comfortable withdrawal from opioid dependence. Buprenorphine is also helpful when used as a “holding” drug for opioid-dependent patients waiting to get into a treatment facility when a bed isn’t immediately available.

Buprenorphine is effective for adults, but…

Almost daily, we read the appalling statistics: 2 million Americans addicted, and over 33,000 overdose deaths a year – nearly 100 people a day. But these horrible statistics, and the call for more buprenorphine, are consistently about adult Americans suffering from substance use disorder. As well as buprenorphine, some interests are still pushing for more methadone availability. Methadone is another replacement drug used to “treat” opioid dependence, but the problem is the treatment can go on for months, years or a lifetime. Meanwhile, we’ve forgotten one colossally important situation. Wherever there are millions of people dependent on opioids there are thousands of dependent babies being born who are hooked on the same opioids as their mothers.

Babies in withdrawal

The condition is called Neonatal Abstinence Syndrome, or NAS. What that means is that babies born to dependent mothers are immediately thrown into “cold turkey” withdrawal because the source of their drugs has suddenly vanished. And it isn’t pretty. NAS babies suffer from terrible gastrointestinal dysfunction, unimaginable aches and pains, temperature instability, high-pitched crying, and numerous central nervous system problems such as shaking, tremors, even life-threatening seizures. In other words, they suffer all the hell and horror that adults go through during a cold-turkey withdrawal from heroin or another opioid. Newborns with drug dependence are quite common these days. According to the National Institute on Drug Abuse (NIDA), NAS births quintupled from 2000 to 2012 — equivalent to one NAS baby being born every 25 minutes. NAS is costing hospitals an estimated $1.5 billion a year. And hospitals everywhere are still learning how best to deal with the NAS epidemic.

Buprenorphine works better for babies too

Roughly 80 percent of babies with NAS are treated with morphine to help reduce the newborn’s opioid withdrawal symptoms during the withdrawal period. The morphine is slowly reduced, balancing it against the withdrawal symptoms. The average hospital stay for newborns under treatment with morphine for NAS is three weeks to a month – compared to 2 days for a normal baby. The cost for the specialized care is enormous. Just keeping NAS babies as comfortable as possible, never mind struggling to keep some of them alive, is well beyond the reach of average Americans. Anything that could reduce treatment time is a welcome advance. And it looks like what’s good for the adults – buprenorphine – may become the new standard for NAS babies. A study at Thomas Jefferson University Hospital in Philadelphia that compared morphine to buprenorphine found that using buprenorphine instead of morphine cuts drug treatment time almost in half, and hospitalization time by a full third. “The median duration of treatment was significantly shorter with buprenorphine than with morphine – 15 days vs 28 days, as was the median length of hospital stay – 21 days vs 33 days,” the researchers said. “Rates of adverse events were similar in the two groups.” The study added that babies in the morphine group had a lower respiratory rate than those in the buprenorphine group. “This potential advantage, along with a longer interval between doses, may allow for investigation of buprenorphine in outpatient settings, a use that was not examined in this trial,” the study said. On a side note, the study said that in-utero exposure to benzodiazepines is associated with worsened symptoms of neonatal abstinence. Other clinical trials are underway to study the use of buprenorphine among benzodiazepine-exposed infants. The clinical trial was funded by NIDA and was published in the New England Journal of Medicine. Good advice for women: If pregnancy is a possibility in your life, avoid any and all addictive substances. If you’re using and also pregnant, don’t stop using the substance until you see a qualified doctor. Best advice for everyone: For any reason other than medical necessity, don’t use or abuse drugs. Period.

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