Use of tincture of opium compared to oral morphine for the treatment of neonatal abstinence syndrome

Authors

  • Suzannah Kokotajlo, PharmD PGY-2 Pediatric Pharmacotherapy Resident, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey.
  • Christine A. Robinson, PharmD Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey; Pediatric Clinical Pharmacy Specialist, Morristown Medical Center, Morristown, New Jersey.
  • Amy Presti, MD, MSCR Neonatologist, MidAtlantic Neonatology Associates, Morristown Medical Center, Morristown, New Jersey.

Abstract

Objective: To evaluate the difference in time until medical clearance when comparing tincture of opium (TO) to oral morphine (OM) in the treatment of neonatal abstinence syndrome (NAS). Design: Retrospective chart review conducted from May 2007 to July 2011. Setting: Level III Neonatal Intensive Care unit at Morristown Medical Center in Morristown, New Jersey. Patients, Participants: Clinical Drug Utilization reports identified 26 neonates who were treated with TO and 25 neonates who were treated with OM for NAS. No patients were excluded. Interventions: Patients were treated with either TO or OM for the indication of NAS. Main Outcome Measure(s): The primary outcome is to compare the time it takes for a baby being treated with TO versus OM for NAS to be medically cleared for discharge. Results: The median time until medical clearance for those treated with TO was 29.5 days compared to 37 days for those treated with OM (p = 0.14). Conclusion: There was no statistically significant difference in the time it takes for a baby being treated with TO versus OM for NAS to be medically cleared for discharge. There are a number of safety benefits in using OM compared to TO. Until further data are collected, it is appropriate to continue treatment of neonates with NAS with OM. Keywords: opium, morphine, neonatal, abstinence DOI:10.5055/jom.2013.0148

References

Substance Abuse and Mental Health Services Administration: Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2010.

The Committee on Drugs: Neonatal drug withdrawal. Pediatrics. 1998; 101(6): 1079-1088.

The Committee on Drugs and The Committee on Fetus and Newborn.: Neonatal Drug Withdrawal. Pediatrics. 2012; 129(2): e540-e560.

Taketomo CK, Hodding JH, Kraus DM, et al.: Pediatric & Neonatal Drug Information Handbook, 18th ed. Hudson, Ohio, Lexi-Comp, Inc., 2011.

Jackson L, Ting A, McKay S, et al.: A randomized controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome. Arch Dis Child Fetal Neonatal Ed. 2004; 89: 300-304.

Kraft WK, Gibson E, Dysart K, et al.: Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial. Pediatrics. 2008; 122(3): e601-e607.

Langenfeld S, Birkenfeld L, Herkenrath P, et al.: Therapy of the neonatal abstinence syndrome with tincture of opium or morphine drops. Drug Alcohol Depend. 2005; 77(1): 31-36.

Finnegan LP, Connaughton JF, Kron RE, et al.: Neonatal abstinence syndrome: assessment and management. Addict Dis. 1975; 2(1-2): 141-158.

Institute for Safe Medication Practices: ISMP’s List of High Alert Medications. Institute for Safe Medication Practices, 2012.

Institute for Safe Medication Practices: Medication Safety Alert: Ongoing Confusion: Paregoric and Opium Tincture. Institute for Safe Medication Practices, June 19, 1996.

Kelly K, Vaida AJ. Recurring confusion between opium tincture and paregoric. Pharmacy Times. June 1, 2003.

The Joint Commission. Sentinel Event Alert # 39. April 11, 2008.

Coyle MG, Ferguson A, Lagasse L, et al.: Diluted tincture of opium (DTO) and phenobarbital versus DTO alone for neonatal opiate withdrawal in term infants. J Pediatr. 2002; 140: 561-564.

Carin I, Glass L, Parekh A, et al.: Neonatal methadone withdrawal. Effect of two treatment regimens. Am J Dis Child. 1983; 137: 1166-1169.

Reckitt Benckiser Pharmaceutical: Suboxone [package insert]. Richmond, VA: Reckitt Benckiser Pharmaceutical, Inc., 2010.

Jones HE, Johnson RE, Jasinski DR, et al.: Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: effects on the neonatal abstinence syndrome. Drug Alcohol Depend. 2005; 79: 1-10.

Fischer G, Johnson RE, Eder H, et al.: Treatment of opioiddependent pregnant women with buprenorphine. Addiction. 2000; 95(2): 239-244.

Published

01/01/2013

How to Cite

Kokotajlo, PharmD, S., C. A. Robinson, PharmD, and A. Presti, MD, MSCR. “Use of Tincture of Opium Compared to Oral Morphine for the Treatment of Neonatal Abstinence Syndrome”. Journal of Opioid Management, vol. 9, no. 1, Jan. 2013, pp. 62-70, https://wmpllc.org/ojs/index.php/jom/article/view/34.