For pregnant women with an opioid use disorder, opioid agonist pharmacotherapy is the recommended therapy and is preferable to medically supervised withdrawal because withdrawal is associated with high relapse rates 55 56 57, ranging from 59% to more than 90% 58, and poorer outcomes. Relapse poses grave risks, including communicable disease transmission, accidental overdose because of loss of tolerance, obstetric complications, and lack of prenatal care. If a woman does not accept treatment with an opioid agonist, or treatment is unavailable, medically supervised withdrawal can be considered under the care of a physician experienced in perinatal addiction treatment and with informed consent; however, to be successful, it often requires prolonged inpatient care and intensive outpatient behavioral health follow up. In some areas, access to opioid agonist pharmacotherapy is limited, and efforts should be made to improve availability of local resources. Early case reports raised concern that withdrawal from opioids during pregnancy could lead to fetal stress and fetal death 59 60. More recent studies find no clear evidence of an association between a medically supervised withdrawal and fetal death or preterm delivery, but long-term follow up data of these women are lacking 61 62 63, particularly in terms of relapse rates. More research is needed to assess safety (particularly regarding maternal relapse), efficacy, and long-term outcomes of medically supervised withdrawal.
Tolerance Data 2009 Keygen 13
2ff7e9595c
Comments