{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T12:22:12Z","timestamp":1756902132185,"version":"3.44.0"},"reference-count":26,"publisher":"The Pediatric Pharmacy Association","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014]]},"abstract":"\n OBJECTIVES:<\/jats:bold> To compare the length of wean and abstinence severity in neonatal and pediatric patients with neonatal abstinence syndrome or iatrogenic opioid dependence treated with a pharmacist-managed, methadone-based protocol compared with physician-managed patients treated with either methadone or dilute tincture of opium (DTO).<\/jats:p>\n \n METHODS:<\/jats:bold> This was a prospective, single-centered, interventional evaluation of 54 pharmacist-managed patients versus 53 retrospective, physician-managed patients. Wean duration and severity of neonatal abstinence syndrome were compared between groups using the Student t<\/jats:italic> test.<\/jats:p>\n \n RESULTS:<\/jats:bold> Significantly shorter wean duration in in utero<\/jats:italic>-exposed pharmacist-managed patients compared with patients on physician-managed DTO (11.7 days vs 24.2 days, p < 0.001), but not compared with patients on physician-managed methadone (11.7 days vs 47 days, p = 0.101). No statistically significant difference was seen in wean duration in iatrogenic-exposed pharmacist-managed patients compared with patients on either physician-managed DTO or methadone (8.69 days vs 14 days, p = 0.096) and (8.69 days vs 9.82 days, p = 0.34), respectively. There were significantly fewer abstinence scores >12 in pharmacist-managed patients versus physician-managed DTO, but not physician-managed methadone (2.05 vs 17.3, p = 0.008 and 2.05 vs 74.3, p = 0.119, respectively). Significantly fewer abstinence scores \u22658 \u00d7 3 consecutively were seen in pharmacist-managed patients compared with patients on either physician-managed DTO or methadone (2.89 vs 11.9, p = 0.01 and 2.89 vs 24, p < 0.001, respectively).<\/jats:p>\n \n CONCLUSIONS:<\/jats:bold> Use of a pharmacist-managed, methadone-based weaning protocol standardizes patient care and has the potential to decrease abstinence severity and shorten duration of wean versus physician-managed patients exposed to opioids in utero<\/jats:italic>. Additionally, a methadone wean of 10% to 20% per day was well tolerated in both neonatal and pediatric patients.<\/jats:p>","DOI":"10.5863\/1551-6776-19.3.165","type":"journal-article","created":{"date-parts":[[2020,10,27]],"date-time":"2020-10-27T20:12:02Z","timestamp":1603829522000},"page":"165-173","source":"Crossref","is-referenced-by-count":4,"title":["Development and Implementation of a Pharmacist-Managed, Neonatal and Pediatric, Opioid-Weaning Protocol"],"prefix":"10.5863","volume":"19","author":[{"given":"Melissa R.","family":"Johnson","sequence":"first","affiliation":[{"name":"1Department of Pharmacy, Children\u2019s Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David R.","family":"Nash","sequence":"additional","affiliation":[{"name":"1Department of Pharmacy, Children\u2019s Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary R.","family":"Laird","sequence":"additional","affiliation":[{"name":"2Department of Neonatology, Children\u2019s Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado"},{"name":"3Pediatrix Medical Group, Children\u2019s Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert C.","family":"Kiley","sequence":"additional","affiliation":[{"name":"2Department of Neonatology, Children\u2019s Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado"},{"name":"3Pediatrix Medical Group, Children\u2019s Hospital Colorado at Memorial Hospital, Colorado Springs, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A.","family":"Martinez","sequence":"additional","affiliation":[{"name":"4United States Air Force, Colorado Springs, Colorado"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3883","reference":[{"issue":"5","key":"i1551-6776-19-3-165-b1","series-title":"Adv Neonatal Care","first-page":"265","article-title":"A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations","volume":"5","year":"2005","unstructured":"Lainwala\n S\n , BrownER, WeinschenkNP, et al. A retrospective study of length of hospital stay in infants treated for neonatal abstinence syndrome with methadone versus oral morphine preparations. Adv Neonatal Care. 2005;5(5):265\u2013272."},{"issue":"4","key":"i1551-6776-19-3-165-b2","series-title":"Anesth Analg","first-page":"1045","article-title":"A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients","volume":"102","year":"2006","unstructured":"Berens\n RJ\n , MeyerMT, MikhailovTA, et al. A prospective evaluation of opioid weaning in opioid-dependent pediatric critical care patients. Anesth Analg. 2006;102(4):1045\u20131050."},{"issue":"1","key":"i1551-6776-19-3-165-b3","series-title":"Addict Dis","first-page":"141","article-title":"Neonatal abstinence syndrome: assessment and management","volume":"2","year":"1975","unstructured":"Finnegan\n LP\n , Connaughton JFJr, KronRE, EmichJP.\n Neonatal abstinence syndrome: assessment and management. Addict Dis. 1975;2(1):141\u2013158."},{"issue":"6","key":"i1551-6776-19-3-165-b4","series-title":"Intensive Crit Care Nurs","first-page":"344","article-title":"Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients","volume":"20","year":"2004","unstructured":"Franck\n LS\n , NaughtonI, WinterI.\n Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients. Intensive Crit Care Nurs. 2004;20(6):344\u2013351."},{"issue":"3","key":"i1551-6776-19-3-165-b5","series-title":"Neurotoxicology","first-page":"597","article-title":"Prenatal narcotic exposure: perinatal and developmental effects","volume":"10","year":"1989","unstructured":"Kaltenbach\n KA\n , FinneganLP.\n Prenatal narcotic exposure: perinatal and developmental effects. Neurotoxicology. 1989;10(3):597\u2013604."},{"issue":"4","key":"i1551-6776-19-3-165-b6","series-title":"Ann Pharmacother","first-page":"473","article-title":"Opioid withdrawal in critically ill neonates","volume":"37","year":"2003","unstructured":"Dominguez\n KD\n , LomakoDM, KatzRW, KellyHW.\n Opioid withdrawal in critically ill neonates. Ann Pharmacother. 2003;37(4):473\u2013477."},{"issue":"10","key":"i1551-6776-19-3-165-b7","series-title":"Cochrane Database Syst Rev","first-page":"CD002053","article-title":"Sedatives for opiate withdrawal in newborn infants","year":"2010","unstructured":"Osborn\n DA\n , JefferyHE, ColeMJ.\n Sedatives for opiate withdrawal in newborn infants. Cochrane Database Syst Rev. 2010;(10):CD002053. doi: 10.1002\/14651858.CD002053.pub3."},{"issue":"2","key":"i1551-6776-19-3-165-b8","series-title":"Pediatr Crit Care Med","first-page":"119","article-title":"Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care patients","volume":"1","year":"2000","unstructured":"Robertson\n CR\n , DarseyE, FortenberryJD, et al. Evaluation of an opiate-weaning protocol using methadone in pediatric intensive care patients. Pediatr Crit Care Med. 2000;1(2):119\u2013123."},{"issue":"9","key":"i1551-6776-19-3-165-b9","series-title":"Paediatr Anaesth","first-page":"805","article-title":"Methadone dosage for prevention of opioid withdrawal in children","volume":"13","year":"2003","unstructured":"Siddappa\n R\n , FletcherJE, HeardA, et al. Methadone dosage for prevention of opioid withdrawal in children. Paediatr Anaesth. 2003;13(9):805\u2013810."},{"issue":"12","key":"i1551-6776-19-3-165-b10","series-title":"Pharmacotherapy","first-page":"1566","article-title":"Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU","volume":"21","year":"2001","unstructured":"Lugo\n RA\n , MacLarenR, CashJ, et al. Enteral methadone to expedite fentanyl discontinuation and prevent opioid abstinence syndrome in the PICU. Pharmacotherapy. 2001;21(12):1566\u20131573."},{"issue":"4","key":"i1551-6776-19-3-165-b11","series-title":"Pediatr Crit Care Med","first-page":"329","article-title":"Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients","volume":"2","year":"2001","unstructured":"Meyer\n MT\n , BerensRJ.\n Efficacy of an enteral 10-day methadone wean to prevent opioid withdrawal in fentanyl-tolerant pediatric intensive care unit patients. Pediatr Crit Care Med. 2001;2(4):329\u2013333."},{"issue":"6","key":"i1551-6776-19-3-165-b12","series-title":"Clin Pediatr","first-page":"592","article-title":"A proposed narcotic withdrawal score for use with newborn infants: a pragmatic evaluation of its efficacy","volume":"14","year":"1975","unstructured":"Lipsitz\n PJ.\n \n \n A proposed narcotic withdrawal score for use with newborn infants: a pragmatic evaluation of its efficacy. Clin Pediatr. 1975;14(6):592\u2013594."},{"issue":"6","key":"i1551-6776-19-3-165-b13","series-title":"Pediatr Crit Care Med","first-page":"573","article-title":"The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients","volume":"9","year":"2008","unstructured":"Franck\n LS\n , HarrisSK, SoetengaDJ, et al. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008;9(6):573\u2013580."},{"key":"i1551-6776-19-3-165-b14","series-title":"Pediatric & Neonatal Dosage Handbook","first-page":"1102","year":"2012","unstructured":"Taketomo\n CK\n , Hodding, JH, KrausDM.\n Pediatric & Neonatal Dosage Handbook. 19th ed.Hudson, OH: Lexi-Comp, Inc; 2012:1102\u20131104,1168\u20131174,1265\u20131266."},{"key":"i1551-6776-19-3-165-b15","series-title":"Med Saf Alert.","article-title":"Medication safety alert: confusion between opium tinctures marks need for community high alert list","year":"May 2006","unstructured":"Institute for Safe Medication Practices. Medication safety alert: confusion between opium tinctures marks need for community high alert list. Med Saf Alert.May 2006. http:\/\/www.ismp.org\/Newsletters\/ambulatory\/archives\/200605_1.asp. Accessed January 2, 2009."},{"issue":"1","key":"i1551-6776-19-3-165-b16","series-title":"Pharmacotherapy","first-page":"1","article-title":"2006 national clinical pharmacy services survey: clinical pharmacy services, collaborative drug management, medication errors, and pharmacy technology","volume":"28","year":"2008","unstructured":"Bond\n CA\n , RaehlCL.\n 2006 national clinical pharmacy services survey: clinical pharmacy services, collaborative drug management, medication errors, and pharmacy technology. Pharmacotherapy. 2008;28(1):1\u201313."},{"issue":"2","key":"i1551-6776-19-3-165-b17","series-title":"Neonatal Netw","first-page":"39","article-title":"Assessment and management of opioid withdrawal in ill neonates","volume":"14","year":"1995","unstructured":"Franck\n LS\n , VilardiJ.\n Assessment and management of opioid withdrawal in ill neonates. Neonatal Netw. 1995;14(2):39\u201348."},{"issue":"5","key":"i1551-6776-19-3-165-b18","series-title":"Crit Care Med","first-page":"763","article-title":"Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion","volume":"22","year":"1994","unstructured":"Katz\n R\n , KellyHW, HsiA.\n Prospective study on the occurrence of withdrawal in critically ill children who receive fentanyl by continuous infusion. Crit Care Med. 1994;22(5):763\u2013767."},{"issue":"1","key":"i1551-6776-19-3-165-b19","series-title":"Nurs Crit Care","first-page":"26","article-title":"Opioid and benzodiazepine withdrawal syndromes in the paediatric intensive care unit: a review of recent literature","volume":"14","year":"2009","unstructured":"Birchley\n G.\n \n \n Opioid and benzodiazepine withdrawal syndromes in the paediatric intensive care unit: a review of recent literature. Nurs Crit Care. 2009;14(1):26\u201337."},{"issue":"2","key":"i1551-6776-19-3-165-b20","series-title":"J Hum Lact","first-page":"184","article-title":"Concentrations of methadone in breast milk and plasma in the immediate perinatal period","volume":"23","year":"2007","unstructured":"Jansson\n LM\n , ChooRE, VelezM, et al. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. J Hum Lact. 2007;23(2):184\u2013190."},{"issue":"4","key":"i1551-6776-19-3-165-b21","series-title":"J Perinat Med","first-page":"344","article-title":"Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome","volume":"35","year":"2007","unstructured":"Dysart\n K\n , HsiehH, KaltenbachK, GreenspanJS.\n Sequela of preterm versus term infants born to mothers on a methadone maintenance program: differential course of neonatal abstinence syndrome. J Perinat Med. 2007;35(4):344\u2013346."},{"issue":"1","key":"i1551-6776-19-3-165-b22","series-title":"Breastfeed Med","first-page":"34","article-title":"Methadone maintenance and long-term lactation","volume":"3","year":"2008","unstructured":"Jansson\n LM\n , ChooR, VelezMA, et al. Methadone maintenance and long-term lactation. Breastfeed Med. 2008;3(1):34\u201337."},{"issue":"6","key":"i1551-6776-19-3-165-b23","series-title":"Pediatrics","first-page":"e1163","article-title":"Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependant mothers","volume":"117","year":"2006","unstructured":"Abdel-Latif\n ME\n , PinnerJ, ClewsS, et al. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependant mothers. Pediatrics. 2006;117(6):e1163\u2013e1169."},{"issue":"1","key":"i1551-6776-19-3-165-b24","series-title":"Pediatrics","first-page":"106","article-title":"Metha-done maintenance and breastfeeding in the neonatal period","volume":"121","year":"2008","unstructured":"Jansson\n LM\n , ChooR, VelezML, et al. Metha-done maintenance and breastfeeding in the neonatal period. Pediatrics. 2008;121(1):106\u2013114."},{"issue":"5","key":"i1551-6776-19-3-165-b25","series-title":"Acta Paediatr","first-page":"768","article-title":"Maternal methadone may cause arrhythmias in neonates","volume":"96","year":"2007","unstructured":"Hussain\n T\n , EwerAK.\n Maternal methadone may cause arrhythmias in neonates. Acta Paediatr. 2007;96(5):768\u2013769."},{"issue":"2","key":"i1551-6776-19-3-165-b26","series-title":"Arch Dis Child Fetal Neonatal Ed","first-page":"F141","article-title":"Maternal methadone therapy increases QTc interval in newborn infants","volume":"96","year":"2011","unstructured":"Parikh\n R\n , HussainT, HolderG, et al. Maternal methadone therapy increases QTc interval in newborn infants. Arch Dis Child Fetal Neonatal Ed. 2011;96(2):F141\u2013F143."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/19\/3\/article-p165.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/meridian.allenpress.com\/jppt\/article-pdf\/19\/3\/165\/1784511\/1551-6776-19_3_165.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/19\/3\/article-p165.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/19\/3\/article-p165.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:42:50Z","timestamp":1747356170000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/19\/3\/article-p165.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014]]},"references-count":26,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.5863\/1551-6776-19.3.165","relation":{},"ISSN":["1551-6776"],"issn-type":[{"type":"print","value":"1551-6776"}],"subject":[],"published":{"date-parts":[[2014]]}}}