SYMPOSIA

LECTURES
[KL-01]
Opioid dependence during pregnancy: Balancing risk versus benefit
Peter Robert Martin
Departments of Psychiatry and Pharmacology, Vanderbilt University, Nashville, Tennessee, USA
E-mail: peter.martin@vanderbilt.edu
Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
Public health consequences of opioid dependence during pregnancy can only be inferred as increasing proportions of opioid-dependent
women are addicted to non-medically prescribed analgesics and receive obstetrical care without being identified as addicted or treated.
Because treatment recommendations for management of opioid dependence in pregnancy have primarily derived from studies in heroindependent
pregnant women, there is a need to characterize and compare the clinical courses and complications of injection drug use
(IDU) and non-medically prescribed opioids. Intrauterine overdose or withdrawal and the neonatal abstinence syndrome (NAS) may occur
regardless of the route of opioid administration; whereas other obstetrical complications are likely consequences of poor prenatal care/selfneglect
typical for IDU. Methadone maintenance compared to active IDU is associated with improved prenatal care, increased fetal growth,
reduced fetal mortality, decreased risk of HIV infection, decreased risk of pre-eclampsia, decreased NAS and reduced foster care placement;
however, significant NAS is still observed in >50% of these births. Benefits of methadone maintenance during pregnancy for addiction to nonmedically
prescribed opioid analgesics may be attributed to support, structure, and prenatal obstetrical oversight compared to the stressful
and chaotic lifestyle of active addiction. While methadone has been the standard of care for >40 years, the Schedule III (methadone is Schedule
II) partial opioid agonist buprenorphine merits examination in pregnancy because it has been found highly effective for treatment of opioid
dependence, is associated with less severe withdrawal and is available in the U.S. under less severe restrictions than methadone. In the MOTHER
study, maternal and neonatal outcomes of treatment with buprenorphine or methadone throughout pregnancy were compared in pregnant
opioid-dependent women, in an international multi-center randomized, controlled, double-blind/double-dummy clinical trial (Jones et al.,
N Engl J Med 2010;363:2320-31). Although comparable numbers of methadone-exposed (57%) and buprenorphine-exposed (47%) babies
required treatment for NAS, buprenorphine-exposed neonates required 89% less morphine to treat NAS; spent 43% less time in the hospital;
and spent 58% less time in the hospital being medicated for NAS. The safety of opioid maintenance treatment during pregnancy must be
judged in the context of comprehensive services (other than the administered medication per se) provided to addicted women by treatment
programs. Buprenorphine is not inferior to methadone but may be preferable in terms of certain fetal outcome measures. Further research is
needed to implement safe buprenorphine induction procedures in pregnant women, to balance reported teratogenic effects of opioids and
benefits of opioid maintenance, and to determine the comparative safety and efficacy of methadone and buprenorphine for mother/fetus
with co-occurring alcohol/benzodiazepine dependence or other psychiatric disorders and the psychoactive medications used to treat them.
Key words: Opioid dependence, pregnancy, buprenorphine, methadone
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S35
[KL-02]
l-Benzylpiperazine, a major contaminant of ecstasy, induces marked changes in rat brain
neurochemistry and behaviour
Alan Leslie Hudson 1 , Nubia Zepeda 1 , Amanda Perreault 1 , Maggie Lalies 1 , Glen Baker 2
1 Department of Pharmacology, University of Alberta, Edmonton, Canada
2 Department of Psychiatry, University of Alberta, Edmonton, Canada
E-mail: ahudson@pmcol.ualberta.ca
Ecstasy [(±) -3-4-methylenedioxymethamphetamine, MDMA] is a widely abused drug which in overdose can lead to serotonin syndrome.
The patient presents with agitation, tremors, and muscle spasms, followed by hyperthermia which can lead to fatal organ failure. Recently
ecstasy tablets have been found to contain piperazines, particularly 1-benzylpiperazine (BZP). The purpose of cutting ecstasy with BZP is
to enhance the psychostimulant effects of MDMA. BZP is also marketed as a “legal high” in some countries; therefore some ecstasy tablets
contain solely BZP. BZP is the active metabolite of an antidepressant drug, trelibet, which failed in clinical trials. There has been little study
on the pharmacological effects of combining BZP with MDMA so we have investigated the bioavailability, neurochemistry and behavioral
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