Development and implementation of a pharmacist-managed, neonatal and pediatric, opioid-weaning protocol
Melissa R Johnson1, David R Nash1, Mary R Laird2
1Pharmacy, Children's Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado.
Summary
Pharmacist-managed methadone protocols significantly reduced neonatal abstinence syndrome (NAS) wean duration and severity compared to physician-managed care, particularly with dilute tincture of opium (DTO). This approach standardizes care and shows potential for improved patient outcomes.
Area of Science:
- Pharmacology
- Neonatal Care
- Pediatric Medicine
Background:
- Neonatal Abstinence Syndrome (NAS) and iatrogenic opioid dependence require effective management strategies.
- Current physician-managed protocols vary, leading to inconsistencies in treatment outcomes.
- Opioid withdrawal management in neonates and pediatric patients presents unique challenges.
Purpose of the Study:
- To compare the efficacy of a pharmacist-managed, methadone-based protocol versus physician-managed protocols (methadone or dilute tincture of opium [DTO]) for treating NAS and iatrogenic opioid dependence.
- To evaluate differences in wean duration and abstinence severity between the management approaches.
- To assess the safety and tolerability of a standardized methadone weaning regimen.
Main Methods:
- A prospective, single-centered study involving 54 pharmacist-managed patients.
- A retrospective comparison with 53 physician-managed patients.
- Statistical analysis using the Student t test to compare wean duration and NAS severity scores.
Main Results:
- Pharmacist-managed patients had significantly shorter wean durations compared to physician-managed DTO (11.7 vs 24.2 days).
- Fewer high abstinence scores (>12 and ≥8 × 3 consecutively) were observed in pharmacist-managed patients compared to physician-managed DTO and methadone groups.
- No significant difference in wean duration was found when comparing pharmacist-managed patients to physician-managed methadone patients for in utero exposure.
Conclusions:
- A pharmacist-managed, methadone-based weaning protocol standardizes care and can decrease abstinence severity and shorten wean duration in neonatal and pediatric patients.
- A daily methadone wean of 10% to 20% was well-tolerated in both neonatal and pediatric populations.
- This approach offers a potential improvement over traditional physician-managed protocols for opioid-exposed neonates and children.
More Related Videos
08:58Development of a Neonatal Piglet Acute Lung Injury Model Recreating the Early Environment of Preterm Infant Lungs
Published on: October 31, 2025
850
06:38Use of a Piglet Model for the Study of Anesthetic-induced Developmental Neurotoxicity AIDN: A Translational Neuroscience Approach
Published on: June 11, 2017
11.7K
Related Concept Videos
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
395
In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
395
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
1.5K
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
1.5K
01:25Analgesia and Pain Management
3.1K
Pain is critical to various clinical pathologies, provoking an urgent need for effective management. Pain, whether acute or chronic, is a complex neurochemical process. Its alleviation depends on the type, with nonopioid analgesics effective for mild to moderate pain, such as musculoskeletal or inflammatory pain, while neuropathic pain responds best to anticonvulsants, tricyclic antidepressants, or serotonin/norepinephrine reuptake inhibitors. For severe acute or chronic pain, opioids may be...
3.1K
01:15Drug Abuse and Addiction: Pharmacological Phenomena
1.6K
Drug dependence, abuse, and addiction are complex phenomena that can precipitate various abnormal states. Physical dependence refers to a state of pharmacological adaptation to a drug. This adaptation often results in tolerance—a reduced response to the drug after repeated administrations. When the drug use is abruptly stopped, withdrawal symptoms occur due to the body's need to readjust from the pharmacologically induced imbalance. However, tolerance and withdrawal symptoms do not...
1.6K
01:26Pharmaceutical Poisoning: Treatment Strategies
250
Treatment strategies for poisoning are a critical aspect of emergency medicine, focusing on preventing the absorption of toxins and enhancing their elimination. When a poisoning incident occurs, the first response is to halt exposure and decontaminate the patient, particularly through gastrointestinal (GI) methods if the poison was ingested.Gastrointestinal Decontamination Techniques:Activated charcoal is the cornerstone of GI decontamination. It works through adsorption, binding the toxin to...
250
01:17Pharmacokinetics in Pediatric Patients: Drug Distribution
532
Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
532