This is a proposal for a training grant that contains plans for research, didactic experiences and supervised clinical experience. This is proposed in order to strengthen existing expertise in the treatment of addictive disorders and, at the same time, gain research experience. This will provide the foundation for a career researching addictive disorders. The safety of controlled, tapered withdrawal from opioids during pregnancy will be studied. Opioid dose will be converted to methadone and tapers of 10% per day will be prescribed. Maternal and fetal wellbeing will be monitored through routine observations of signs and symptoms of opioid withdrawal, fetal response will be monitored with daily Biophysical Profiles, fetal movement counts, fetal heart rate counts and doppler blood flow studies. Serum methadone will be monitored. It is expected that withdrawal will be accomplished without significant fetal distress, supporting this as a treatment option for pregnant opioid addicts. Psychosocial support during and after withdrawal will be provided and neonatal outcome measures recorded. This study will expand on techniques already developed by Dr. Schnoll and his colleagues to study cocaine withdrawal during pregnancy. Methadone maintenance is clearly the treatment of choice for pregnant opioid-dependant women. These women continually cycle between intoxication and withdrawal when using illicit drugs, and there is no clinical understanding of the effects of these cycles on the fetus. Given the change in methadone metabolism during pregnancy, women on methadone as it is conventionally given may cycle from intoxication to withdrawal just as if they were using illicit drugs [36, 37]. In addition, there are only methadone programs in the Virginia and many pregnant opioid-dependant women live in localities where methadone maintenance is not available, and therefore must be withdrawn. Because of these realities and the fact that some women prefer options other than methadone maintenance, it will be useful to learn how to withdraw these women with the least adverse affect on the fetus and the pregnancy.
