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Letters to the Editor
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Methadone
Pregnant women should be carefully supervised
From Dr M. R. Mohan and Dr J. Guirguis
Babies of women who misuse opiates are more likely than others to be premature
and of low birth weight. They may also show withdrawal symptoms after birth
such as irritability, restlessness, tremor and a high pitched cry. These
symptoms are collectively called “fetal absence syndrome”.
The symptoms are delayed if the mother was taking methadone as opposed
to heroin, because methadone has a longer half-life (one to two days).
Studies indicate that women in methadone maintenance programmes have pregnancies
with a better outcome than opiate-dependent mothers without methadone therapy.1 In addition, women in these programmes show less risky injecting behaviour
and lower rates of HIV infection because the methadone is prescribed as
a liquid, which is formulated to discourage attempts to inject it. An influential
meeting of experts in the US concluded that the safety and efficacy of
methadone maintenance treatment has been unequivocally established.2
Methadone doses above 60mg per day are often required to prevent heroin
use. However the starting doses should be determined by specialists and
be adjusted according to the patient’s initial use in order to prevent
accidental overdose.
Community pharmacists play a pivotal role in supervising the dispensing
of methadone on a regular basis. However, one point of concern is morning
sickness because it can cause vomiting of methadone soon after it is swallowed.
Close liaison between community pharmacists and patients’ key workers
is essential to achieve quick replacement prescriptions, address the prescribing
of a safe antiemetic, and report immediately the patient drops out of treatment.
Mylavarapu Mohan
Clinician
Joseph Guirguis
Consultant Addiction Psychiatrist
Wolverhampton City NHS PCT
References
1. Ward J, Hall W, Mattick RP. (1999). Role of maintenance treatment
in opioid dependence. Lancet 1999;353:221–6.
2. National Consensus Development Panel. Effective medical treatment
of opiate addiction. JAMA 1998;280:1936–43. |
The
Pharmaceutical Journal