Document Type


Publication Date

Spring 2015


Evidence-based practice with pregnant clients who are opioiddependent can be especially challenging because pregnant women are rarely included in clinical trials. The paper synthesizes systematic reviews on the outcomes of medication-assisted treatment for opioid dependent pregnant women and compares the effectiveness of methadone and buprenorphine. We explore evidence on maternal and neonatal outcomes, the safety of breastfeeding, and discuss the implications for social work practice. Searches were conducted in 6 databases. Ten reviews met the inclusion criteria. Results suggest medication-assisted treatment with either methadone or buprenorphine are equally effective in reducing maternal substance use, although methadone may offer slightly higher treatment retention rates when flexible dosing is implemented. Physical parameters and Apgar scores at birth show no significant differences in neonates exposed to methadone versus buprenorphine. Rates of treatment for neonatal abstinence syndrome also do not differ. However, when treatment is required burprenorphine may produce a shorter duration of withdrawal. Data on long-term developmental outcomes following in-utero exposure to opioid maintenance medications is inconclusive. Results suggest that there is minimal transmission of either methadone or buprenorphine to the neonate in breast milk. Conclusions are limited by missing data on broader psychosocial and maternal health outcomes. Evidence on long-term developmental outcomes for neonates is also confounded by prenatal drug exposure and environmental factors. Social workers engage with opioid-dependent pregnant women in many settings and can play an important role in ensuring access to treatment, and in addressing misconceptions around medication-assisted treatment for pregnant women with family members, peer supports, and other health care providers.

Publication Title

Journal for the Society of Social Work and Research




The Society of Social Work and Research





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Social Work Commons