Study suggests dose reduction does not prevent severe neonatal opioid withdrawal

A study published in JAMA Network Open indicates that reducing doses of methadone or buprenorphine during pregnancy does not effectively prevent severe neonatal opioid withdrawal syndrome (NOWS). Researchers from the University of Maryland School of Medicine found that neither maternal medication doses nor drug levels measured in umbilical cord tissue were associated with the severity of withdrawal in newborns.

The findings suggest that lowering medication for opioid use disorder (MOUD) doses is not a viable strategy for protecting infants from severe symptoms. Instead, the research reinforces the importance of maintaining consistent treatment to protect pregnant patients from the risks of relapse and overdose. While newborns exposed to methadone tended to experience NOWS more frequently or severely than those exposed to buprenorphine, the specific reasons for this difference remain poorly understood.

By measuring medication and metabolite levels directly in umbilical cord tissue, investigators obtained a more objective measure of third-trimester drug exposure compared to serum or urine testing. The study aims to address clinical concerns that may lead patients or providers to inappropriately adjust medication levels during pregnancy.