What is the role of buprenorphine in the pathogenesis of neonatal abstinence syndrome (NAS)?

Updated: Dec 20, 2017
  • Author: Ashraf H Hamdan, MD, MBBCh, MSc, MRCP, FAAP; Chief Editor: Santina A Zanelli, MD  more...
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Buprenorphine, a semi-synthetic opioid, is a more recently approved medication for treating opioid addiction and dependence. The Suboxone and Subutex preparations were approved for this indication by the United States Food and Drug Administration (FDA) in October 2002. A review suggested that buprenorphine and methadone have comparable maternal efficacy. Although methadone seems superior in terms of retaining patients in treatment, infants who had prenatal exposure to buprenorphine required significantly less morphine for the treatment of NAS, a significantly shorter period of NAS treatment, and a significantly shorter hospital stay than did infants with prenatal exposure to methadone. [13, 14]

The relationship between maternal buprenorphine dose and either NAS incidence or severity has been inconsistent. Secondary analysis study of data from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study failed to support any relationship between maternal buprenorphine dose at delivery and NAS severity, total amount of morphine needed to treat NAS, duration of treatment, or duration of hospital stay. [15]  A more recent study indicated that polysubstance exposure was the most potent predictor of NAS severity in a group of buprenorphine-exposed neonates; there was a positive association between maternal buprenorphine dose and lower infant birth weight and length. [16] In another study, preliminary findings suggest that although marijuana exposure in the third trimester does not appear to complicate the pregnancy or the delivery process, such exposure may impact the severity of NAS, particularly the likelihood of needing pharmacologic therapy for NAS and the duration of hospital stay. [17]

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