Perinatal EvidenceCompass
Prepopulated workbenchMED-212

Substance-use disorder — opioid

Methadone (oral OUD treatment)

Opioid use disorder maintenance; also a pain medication in other settings

Not a categorical safety rating

This record organizes questions; it does not close them.

The clinical fields and position statements are prepopulated from the public-source corpus. They have not completed individual dual extraction, formal appraisal, exact-label reconciliation, or multidisciplinary sign-off. Do not use this page to justify abrupt discontinuation or reflexive switching.

Inventory identity

What this record represents

Canonical generic name
Methadone (oral OUD treatment)
Entity type
single-ingredient drug
Active component(s)
Methadone
Formulation / route / interval
Oral solution/tablet administered through regulated opioid treatment programs
Attachment entry
Methadone
Separate monograph status
Yes — distinguish OUD program use from analgesic use
Identity and cross-reference
Not populated in v0.95
Inventory verification confidence
Moderate — molecule-level source; exact product/jurisdiction pending

Decision taxonomy

Five positions kept separate

These are workbench statements for reviewer execution. They are not independently commissioned, patient-specific recommendations.

  1. 01

    Stable continuation

    Workbench statement

    Do not withhold or discontinue solely because of pregnancy or lactation. For this record, assess indication, prior response, relapse severity, dose/formulation, alternatives, exposure timing, and mapped evidence; individual commissioned adjudication remains pending.

  2. 02

    New initiation in pregnancy

    Workbench statement

    For a new start, prefer an effective option with the strongest diagnosis-specific efficacy and reproductive evidence when clinically suitable. This record has not received an individual, independently verified initiation ranking.

  3. 03

    Switch before conception

    Workbench statement

    Before conception, consider a switch only when expected benefit exceeds relapse, withdrawal, failed-switch, and dual-exposure risks. Build and monitor the plan before pregnancy when feasible; no universal switch direction is assigned here.

  4. 04

    Unplanned exposure

    Workbench statement

    After unplanned exposure, confirm product, route, dose, timing, indication, co-exposures, and symptoms; do not advise abrupt cessation. Use the mapped evidence and current label to decide whether any targeted fetal assessment is indicated.

  5. 05

    Delivery, postpartum & lactation

    Workbench statement

    Create separate delivery, postpartum-dose, neonatal-observation, and lactation plans. Do not infer breastfeeding suitability from pregnancy evidence or routinely taper before delivery without drug-specific support.

Linked evidence

3 mapped claim summaries

Mapping can include class-wide, framework, formulation, regulatory, or evidence-gap claims. A linked claim is not necessarily a drug-specific causal estimate.

C-001Provisional public source

Methadone and buprenorphine are recommended treatments for opioid use disorder in pregnancy; medically supervised withdrawal is not preferred because relapse and treatment loss can be dangerous.

Public-source certainty descriptor
High guideline consensus; not GRADE-rated here
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
Pregnancy
Comparator
Agonist treatment versus withdrawal or untreated OUD
Effect or numbers carried forward

No single pooled effect used

Limitations

Guideline recommendation integrates indirect and observational evidence; access and prior response matter

Sources, citation controls, and verification state

Linked sources

PMID
21142534
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
C-002Provisional public source

Buprenorphine produced less severe neonatal withdrawal-treatment burden than methadone among infants in the MOTHER randomized trial, while both drugs treated maternal OUD.

Public-source certainty descriptor
Moderate; randomized trial with important attrition
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
Pregnancy through neonatal hospitalization
Comparator
Sublingual buprenorphine versus methadone
Effect or numbers carried forward

Primary trial reported less morphine treatment and shorter hospital course with buprenorphine

Limitations

Selected trial population and differential discontinuation limit generalizability; neonatal protocols have evolved

Sources, citation controls, and verification state

Linked sources

PMID
21142534
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending
C-010Provisional public source

Breastfeeding is generally supported for patients stable on methadone or buprenorphine when there is no separate contraindication; current nonprescribed exposure is assessed separately.

Public-source certainty descriptor
Moderate guideline consensus; observational infant evidence
Formal appraisal
Not started — full text and independent appraisal pending
Exposure window
Postpartum lactation
Comparator
Breastfeeding versus formula in stable treated OUD
Effect or numbers carried forward

Low milk transfer for buprenorphine; established experience for both

Limitations

Maternal stability, HIV policy, polysubstance exposure, infant prematurity and sedation require individual review

Sources, citation controls, and verification state

Linked sources

PMID
Not populated in v0.95
DOI
Pending DOI verification
Exact locator
Pending exact table/figure/page/supplement locator
Access date
2026-07-29
Integrity check
Same-day source surveillance recorded; source-by-source correction/retraction verification remains pending
Internal verification
Source-linked; independent external verification pending