research critique

A Critique of the Research Article: Methadone/Buprenorphine and Better Maternal/ Perinatal Outcomes: A Meta-analysis

Winston-Salem State University

A Critique of the Research Article: Methadone/Buprenorphine and Better Maternal/ Perinatal Outcomes: A Meta-analysis
Abstract
The purpose of this research article is to discuss lower risk drugs such as Methadone and Buprenorphine given to Heroin addicted pregnant patients to create better neonatal and maternal outcomes. This research articles discusses the gold standard of treatment for better neonatal and maternal outcomes.
Keywords: heroin, neonatal, maternal, outcomes, methadone, buprenorphine, gold standard treatment

A Critique of the Research Article: Methadone/Buprenorphine and Better Maternal/ Perinatal Outcomes: A Meta-analysis
Methadone is a synthetic opioid. It is used medically as an analgesic and a maintenance anti-addictive and reductive preparation for use by patients with opioid dependency. It was developed in Germany in 1937. Methadone was introduced into the United States in 1947 by Eli Lilly and Company. The principal effects of methadone maintenance are to relieve narcotic craving, suppress the abstinence syndrome, and block the euphoric effects associated with opiates. When used correctly, Methadone maintenance has been found to be medically safe and non-sedating. It is also indicated for pregnant women addicted to opiates. (doi:http//en.wikipedia.org/wiki/methadone)
The theoretical study was not discussed in the articles but Roy’s Model identifies the elements considered essential to adaptation and describes how the elements interact to produce adaptation and thus health. Methadone helps the pregnant opioid dependent individual adapt to a lower risk drug and produces an overall healthier maternal and prenatal outcome.
Middle Range Theory is less abstract and narrowed in the scope than conceptual models. These types of theories focus on answering particular practice questions and often specify such factors: patient’s health conditions, family situations and nursing actions. While researching this topic there were areas that were discussed, about patients being afraid to seek Methadone treatment and prenatal care because they were ashamed of how health care professionals would view them. It was also stated that patients in better overall health and less family related stress situations would more than likely be the ones to receive proper prenatal care and seek Methadone treatment.
Opioid dependent pregnant patients and their fetus have more physical, mental and psychological issues. (Kaltenbach, Berghella, & Finnegan, 1998). Opioid dependent pregnant patients are at an increased risk for preterm delivery and low birth weight. (Fajemiroku-Odudeyi et al., 2005). To lower the health risks, pregnant women who are opiate dependent have been treated with methadone maintenance, the standard of care for several decades. (Jones et al., 2005). Another treatment option became available when the U.S. Food and Drug Administration approved the use of buprenorphine maintenance therapy in 2002, which is another substitute for methadone. The research article “Opioid Dependency in Pregnancy and Length of Stay for Neonatal Abstinence Syndrome” examines 152 opioid-dependent pregnant women on methadone maintenance therapy (n=136 the participants that are using methadone) or buprenorphine maintenance therapy (n=16 the participants that are using buprenorphine) during pregnancy and their neonates. The neonates were born between January 1, 2005 and December 2007. The use of methadone in opioid dependent pregnant women lowers maternal morbidity and mortality rates and promotes fetal stability and growth compared to the use of heroin (Ludlow, Evans, & Hulse, 2004). Continuous methadone treatment during pregnancy is associated with improved earlier antenatal care (Burns, Mattick, Lim & Wallace, 2007), compliance with prenatal care and better preparation for infant care and parenting responsibilities (Dawe, Harnett, Rendalls, & Staiger, 2003). Stabilization on methadone avoids the dangers of repeated intoxication and withdrawal cycles. Methadone has to be picked up by the patient at the treatment facilities. Attendance at these facilities allow pregnant patients opportunities to receive essential antenatal care and advice for a healthy pregnancy, which some of the patients otherwise may not receive. While conducting this research it was not clearly evident what was being researched until the conclusion of the results was determined. Based on the number of participants depended on the outcome of the better treatment. Therefore the results are not as accurate as could be if there were a larger amount of participants. There were no violations of patient rights with the methods used. The research article “Methadone in pregnancy: treatment retention and neonatal outcomes” examines three different groups of women: a group who entered continuous treatment at least one year prior to birth, a group who entered continuous treatment in the 6 months prior to birth, and a group whose last treatment program prior to birth ended at least one year prior to birth. Births that occurred after 1994 were selected for this analysis. Overall, 2 993 women were on the methadone program at delivery. The number of births rose steadily from 62 in 1992 to 459 in 2002. A particular strength of the large sample size was the ability to examine the effect of treatment retention on key neonatal outcomes. Among mothers on methadone at delivery, early commencement on methadone was associated with increased antenatal care and reduced prematurity. This is consistent with previous research that has shown that methadone in conjunction with adequate prenatal care promotes fetal stability and growth. Ethics approval for the project was granted by the NSW Department of Health Ethics Committee. All data was provided to the researchers’ only once full identification of records had taken place with password protected computers and firewall protection. This method was used to protect patient’s rights. Based on a large sample size, researchers were able to examine the effects of treatment retention on key neonatal outcomes. Although researchers had a large sample size based on certain ethical restrictions, limited the amount of information given to researchers, which waived the outcomes of individual’s results not being totally accurate. The research article “Methadone and perinatal outcomes: a prospective cohort study” examines A total of 117 pregnant women on methadone maintenance treatment recruited between July 2009 and July 2010. Measurements information on concomitant drug use was recorded with the Addiction Severity Index. Perinatal outcomes included pre-term birth (