Improving Maternal Outcomes with Methadone High-dose Stabilization and 72hour Dispensing in the Setting of Fentanyl Use

This presentation will be featured at Indonesia 2025, on the 18.09.2025.

Author: Vania Rudolf, MD, MPH, DFASAM - Chair, Women and Addiction IG, International Society of Addiction Medicine (ISAM),President,                  Washington Society of Addiction Medicine

Abstract:

Disparities remain prevalent for individuals with OUD in perinatal care settings in the United States, and the ability to access and express full health potential is limited for individuals who use drugs when they are not provided with standard and lifesaving care throughout their pregnancy. Pregnant and postpartum people continue to have higher rates of maternal morbidity, overdose, medical complications, preterm births, and untreated or ignored chronic conditions. This leads to preventable mortality, addiction complications, and physical or cognitive injury to people, which may cause long-lasting mental health impacts.

Pregnant and postpartum people with Opioid Use Disorder (OUD) are directly impacted by a fragmented health care system built upon stigma-related barriers to care that lead to negative health consequences. Methadone is an essential component of perinatal OUD treatment that alleviates withdrawal and cravings, further preventing problematic use that may impact the family unit.

The careful stabilization with split Methadone dosing is paramount for maternal and fetal stability. Pregnancy significantly alters methadone pharmacokinetics due to increased plasma volume and hepatic metabolism. This oral presentation aims to review the benefits of MOUD for pregnant patients using fentanyl that stabilized on high dose methadone (>100mg daily) and received up to 72-hour dispensation upon hospital discharge and its evidence related to overdose prevention, maternal and fetal health, and opioid treatment program (OTP) linkage to care.

The oral presentation will highlight data and outcomes of 79 perinatal people who presented for inpatient methadone stabilization; will demonstrate the effectiveness of methadone at higher than traditional doses, with twice daily dosing being the standard of care and the availability of 72-hour dispensing for reduction of hospital LOS and linkage to care. It will emphasize understanding of the effectiveness of perinatal Methadone and harm reduction outcomes to facilitate MOUD stability, ongoing treatment engagement, wellness and optimal outcomes.