Methadone or Buprenorphine: Equal in Treating Opioid Dependent Parturients?

Opioid use and misuse in parturients manifests in almost six out of every 1000 births, with close to 22,000 infants born annually to women using opiates. Additionally, the associated costs in managing these pregnant patients and their infants have increased to $1.5 billion annually. The American College of Obstetricians and Gynecologists currently recommends sublingual buprenorphine and oral methadone as the two opioid pharmacotherapy options for the treatment of opioid use disorder in pregnant patients. However, the pharmacology of buprenorphine and methadone differs greatly, making initiation and management of these two medications complex. Thus, it is crucial for anesthesia providers and obstetrical teams to have a thorough understanding of these two opioids and become familiarized with the current evidence-based practice for the management of parturients undergoing medication for opioid use disorder during pregnancy. In this journal course, the differences between the pharmacology of buprenorphine and methadone are described and benefits and limitations associated with the use of methadone and buprenorphine in parturients are discussed based on the current research data.