Opioid use disorder — MCCQE Part 1 MCQ

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HardSubstance UseOpioid use disorderMCCQE Part 1

A patient at 10 weeks' gestation has opioid use disorder and has been stable on methadone for eight months without ongoing non-prescribed opioid use. She asks to stop methadone abruptly today because she fears neonatal withdrawal. What is the best plan?

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Correct answer: C — Continue OAT and coordinate pregnancy-specific care

Effective opioid agonist treatment should not be stopped abruptly because pregnancy has begun. Sudden withdrawal and relapse expose both patient and fetus to substantial risk, including overdose, unstable opioid concentrations, and loss of prenatal care. Methadone and buprenorphine are accepted first-line OAT options during pregnancy. A patient already stable on methadone is generally continued with addiction, obstetric, pharmacy, and pediatric coordination; physiologic changes may require individualized dose or schedule adjustments. Neonatal opioid withdrawal can occur, but it is anticipated and treatable and does not outweigh the maternal and fetal benefits of stable OAT. Naltrexone is not an automatic substitute for a patient physically dependent on an opioid agonist. Shared decision-making, naloxone access, harm reduction, infectious-disease care, and non-stigmatizing prenatal support should accompany treatment.

Reference: CRISM 2024 OUD Update: https://crism.ca/wp-content/uploads/2024/11/E1280.full_.pdf ; PHAC Maternity Guideline: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/healthy-living/maternity-newborn-care-guidelines-chapter-3/64-03-19-2445-fcng-chapter-3-en-final.pdf