recent dramatic headlines in lay and professional media worldwide have focused on an article from the UK , whose findings are interpreted as attributing visual problems in children to pre-natal exposure to methadone. In fact, the article, which describes 20 children referred to specialists because of concerns over visual function, is very conservative in its conclusions. Specifically, “Infants born to drug-misusing mothers prescribed methadone in pregnancy are at risk of a range of visual problems, the underlying causes of which are not clear” (emphasis added). Even this seems to understate the tenuousness of the possible relationship between prenatal exposure to methadone and the eye problems noted here. Thus, the mothers may have received methadone for one day before delivery, or for the entire period of gestation; to the extent methadone maintenance had been provided for an extended period of time, no clue is given as to dosages – and whether they were adjusted individually based on clinical outcomes. In light of this lack of information, it's not clear how one should interpret the unqualified generalization that these were children born to “drug-misusing mothers”; one must hope this does not reflect the authors' view that all patients receiving prescribed methadone should be characterized as "misusing" drugs. The disquietude in this regard is heightened, however, by the reference to “children who had been exposed to substitute methadone and other drugs of misuse” (emphasis added).
As in the case of any therapeutic regimen, all possible risks should be assessed and considered both by the provider and recipient of methadone treatment, and weighed against the likelihood of success or failure of other management options. In this regard, the bottom line is that there is no treatment of opioid dependence that is as effective as methadone maintenance – for the pregnant patient and her unborn child as well as for all others who want and need help for their addiction.
Original article: R Hamilton et al. downloaded from bjo.bmj.com 22 April 2010