Confounding of the Comparative Safety of Prenatal Opioid Agonist TherapySusan B Brogly1*, Kristen A Hahn2, Sonia Hernandez Diaz3 and Martha Werler2
- Corresponding Author:
- Brogly SB
Department of Medicine
Queen’s University, Etherington Hall
94 Stuart St., Kingston, ON Canada K7L 3N6
Tel: (613) 549-6666 ext 8227
Fax: (613) 548-2428
E-mail: [email protected]
Received date: November 12, 2015 Accepted date: December 25, 2015 Published date: December 31, 2015
Citation: Brogly SB, Hahn KA, Diaz SH, Werler M (2015) Confounding of the Comparative Safety of Prenatal Opioid Agonist Therapy. J Addict Res Ther 6:252. doi:10.4172/2155-6105.1000252
Copyright: © 2015 Brogly SB, et al., This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Prenatal opioid agonist therapy with methadone or buprenorphine prevents maternal illicit opioid use and withdrawal and improves pregnancy outcomes compared to heroin use alone. Historically, methadone has been the first-line opioid agonist therapy for pregnant opioid dependent women; in recent years buprenorphine has become first-line treatment for some opioid dependent pregnant women. While there is some evidence of better outcomes in neonates exposed to buprenorphine vs. methadone, the effect of confounding from differences in women who use buprenorphine and methadone has not been carefully examined in most studies. This review explores mechanisms by which confounding can arise in measuring associations between prenatal buprenorphine vs. methadone exposure on neonatal outcomes using a graphical approach, directed acyclic graphs. The goal of this paper is to facilitate better understanding of the factors influencing neonatal abstinence syndrome and accurate assessment of the comparative safety of opioid agonist therapies on the neonate.