What is it about?
This article describes the use of divided methadone dosing to manage opioid withdrawal in two pregnant patients with opioid use disorder. It outlines the physiologic and pharmacokinetic changes in pregnancy that alter methadone metabolism and explains how split dosing was used to achieve symptom control. The cases illustrate a collaborative approach involving addiction medicine, psychiatry, and obstetrics.
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Why is it important?
Opioid use disorder in pregnancy is increasing, yet many clinicians lack structured guidance on methadone titration during gestation. Pregnancy accelerates methadone metabolism, making once-daily dosing insufficient for many patients and contributing to undertreated withdrawal, premature self-discharge, and poor treatment engagement. This report provides practical clinical evidence supporting divided dosing as a safe and effective strategy to maintain therapeutic methadone levels, stabilize withdrawal, and promote maternal–fetal wellbeing.
Perspectives
This publication reinforces the need for precise, evidence-informed strategies when treating opioid use disorder in pregnant patients – a population with high clinical complexity and limited access to standardized protocols. Engaging with this work has deepened my commitment to advancing interdisciplinary, patient-centered approaches in perinatal addiction care and to promoting clinical practices that improve safety, adherence, and outcomes for both mother and infant.
Sitara Soundararajan
Brigham and Women's Hospital/Harvard Medical School
Read the Original
This page is a summary of: Opioid use disorder in pregnancy: A strategy for using methadone, December 2023, Frontline Medical Communications, Inc.,
DOI: 10.12788/cp.0427.
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