The increased use of opioids in many countries has resulted in a substantial increase in neonatal opioid withdrawal syndrome (NOWS), a condition which can still occur even if an infant is exposed to an opioid antagonist in utero rather than opioids.
Newborns affected by NOWS often require medication to manage withdrawal symptoms, as well as additional care which often necessitates a longer hospital stay. The long-term effects of opioid exposure in the womb and NOWS are as-yet unclear.
New research conducted by Boston Medical Centre has shown some promising initial findings of naltrexone use in pregnancy, as opposed to other opioid antagonists. The infants of participants taking naltrexone showed no immediate symptoms of NOWS, and of those showing eventual symptoms fewer than usual required medication. Most of the participants breastfed, and this caused no immediate issues.
The participants also found it easier to avoid opioid use during pregnancy when taking naltrexone. None of the participants reported opioid use, nor was there any indication of use in urine toxicology reports.
The researchers are now calling for a larger and longer-term study of naltrexone use during pregnancy. If the initial findings are substantiated, the relatively new treatment may become another safe option or even preferable to the current favoured treatment, buprenorphine.
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Wachman EM, Saia K, Miller M, Valle E, Shrestha H, Carter G, et al. Naltrexone Treatment for Pregnant Women With Opioid Use Disorder Compared With Matched Buprenorphine Control Subjects. Clin Ther. 2019 Jul 27. pii: S0149-2918(19)30346-7. DOI: 10.1016/j.clinthera.2019.07.003. [Epub ahead of print]