Substance use: opioid dependence in pregnancy: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Substance use: opioid dependence in pregnancy

Sample item

A woman with heroin dependence presents at 14 weeks of pregnancy wanting to stop. Which management is generally recommended?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Opioid agonist maintenance with methadone or buprenorphine

Repeated cycles of intoxication and withdrawal expose the fetus to stress, with a risk of miscarriage, preterm labour and fetal distress. Maintenance on a long-acting opioid agonist stabilises the mother, reduces illicit use and improves antenatal care, and the neonate can be treated for abstinence if it develops.

Option by option

  • A. Clonidine-assisted detoxification as an outpatient

    Clonidine causes maternal hypotension and does not address the risk of relapse.

  • B. Supervised abrupt withdrawal without substitution

    Abrupt withdrawal risks fetal distress, miscarriage or preterm labour and high relapse.

  • C. Opioid agonist maintenance with methadone or buprenorphine (correct)

    Correct. Stable agonist maintenance avoids fetal exposure to repeated withdrawal.

  • D. Immediate cessation and starting naltrexone

    Naltrexone would precipitate withdrawal and has limited safety data in pregnancy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is C, Opioid agonist maintenance with methadone or buprenorphine. Repeated cycles of intoxication and withdrawal expose the fetus to stress, with a risk of miscarriage, preterm labour and fetal distress.

Why is "Clonidine-assisted detoxification as an outpatient" not the answer?

Clonidine causes maternal hypotension and does not address the risk of relapse.

Why is "Supervised abrupt withdrawal without substitution" not the answer?

Abrupt withdrawal risks fetal distress, miscarriage or preterm labour and high relapse.

Why is "Immediate cessation and starting naltrexone" not the answer?

Naltrexone would precipitate withdrawal and has limited safety data in pregnancy.

What concept does this question test?

It tests Substance use: opioid dependence in pregnancy in Psychiatry. Maintenance on a long-acting opioid agonist stabilises the mother, reduces illicit use and improves antenatal care, and the neonate can be treated for abstinence if it develops.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Substance use: opioid dependence in pregnancy?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.