Revised dose schema of sublingual buprenorphine in the treatment of the neonatal opioid abstinence syndrome

Addiction. 2011 Mar;106(3):574-80. doi: 10.1111/j.1360-0443.2010.03170.x. Epub 2010 Oct 6.


Aims: More than half of infants exposed to opioids in utero develop neonatal abstinence syndrome (NAS) of severity to require pharmacological therapy. Current treatments are associated with prolonged hospitalization. We sought to optimize the dose of sublingual buprenorphine in the treatment of NAS.

Design: Randomized, Phase 1, open-label, active-control clinical trial comparing sublingual buprenorphine to oral morphine.

Setting: Large, urban, tertiary care hospital.

Participants: Twenty-four term infants requiring pharmacological treatment for NAS.

Measurements: Outcomes were neonatal safety, length of treatment and length of hospitalization.

Findings: Sublingual buprenorphine was safe and effective. Infants treated with buprenorphine had a 23-day length of treatment compared to 38 days for those treated with morphine (P = 0.01), representing a 40% reduction. Length of hospital stay in the buprenorphine group was reduced 24%, from 42 to 32 days (P = 0.05).

Conclusions: Sublingual buprenorphine was safe in NAS, with a substantial efficacy advantage over standard of care therapy with oral morphine.

Trial registration: NCT00521248.

Publication types

  • Clinical Trial, Phase I
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Sublingual
  • Adult
  • Birth Weight
  • Buprenorphine / administration & dosage*
  • Buprenorphine / adverse effects
  • Cytomegalovirus Infections / etiology
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hypnotics and Sedatives / administration & dosage
  • Infant, Newborn
  • Length of Stay / statistics & numerical data
  • Male
  • Morphine / administration & dosage*
  • Morphine / adverse effects
  • Narcotic Antagonists / administration & dosage*
  • Narcotic Antagonists / adverse effects
  • Neonatal Abstinence Syndrome / drug therapy*
  • Opiate Substitution Treatment / methods
  • Phenobarbital / administration & dosage
  • Pregnancy
  • Severity of Illness Index
  • Treatment Outcome


  • Hypnotics and Sedatives
  • Narcotic Antagonists
  • Buprenorphine
  • Morphine
  • Phenobarbital

Associated data