Joseph R. Hageman, MD 

I was impressed as I reviewed a large cohort study done in Massachusetts by Suarez and colleagues at Brigham and Women’s Hospital and Harvard Medical School using national data from 2010-2018 from 2,548,372 pregnancies of pregnant women enrolled in public insurance programs using buprenorphine versus methadone for opioid use disorder (1). Several important findings begin with the lower risk of adverse neonatal outcomes associated with buprenorphine use compared with methadone in pregnancy (1). However, the risk of adverse maternal outcomes was similar (1). 

• Neonatal abstinence syndrome (NAS) was seen in 52% of those infants exposed to buprenorphine in the 30 days before delivery compared to 69.2% of infants exposed to methadone in the 30 days prior to delivery (adjusted relative risk 0.73, 95% con. Int. 0.71-0.75) (1). 
• Preterm birth in early pregnancy was seen in 14.4% of infants born to mothers exposed to buprenorphine compared to 24.9% of infants exposed to methadone ( adjusted relative risk 0.58 (95% C.I. 053-062) (1). 
• Severe maternal complications were seen in 3.3% of buprenorphine pregnant women compared with 3.5% methadone pregnant women (adjusted relative risk 0.91 with 95% confidence interval 0.74-1.13) (1). 
• One other point that the authors made was that the buprenorphine mothers were felt to receive better overall care compared with the methadone mothers (1). 

References 

1. Suarez EA, Huybrechts KF, Straub S, et Al. Buprenorphine versus Methadone for Opioid Use Disorder in Pregnancy. N E J Med 2022; 387 (22): 2033-2044. https://www.nejm.org/doi/full/10.1056/NEJMoa2203318

Disclosures: The author has no disclosures