Which statement accurately reflects NAS pharmacologic treatment with regard to current evidence?

• A. Oral morphine solution and methadone are supported when pharmacologic treatment is indicated
• B. Buprenorphine is clearly superior to morphine or methadone
• C. Clonidine alone is ineffective for NAS
• D. No pharmacologic treatment is recommended

Answer: (A)

Current evidence supports using opioid-based pharmacologic therapy for NAS when treatment is needed, with morphine or methadone being the best-supported options. After initial nonpharmacologic care and careful assessment for withdrawal severity, infants with moderate to severe NAS often respond well to opioid analgesics that taper over time. Both oral morphine and methadone have robust clinical data showing they reduce withdrawal symptoms and enable successful weaning from therapy.

Buprenorphine has shown benefit in some studies and may offer certain advantages in specific settings, but it is not universally proven to be clearly superior to morphine or methadone in all trials, so it isn’t considered the definitive first-line choice in every case. Clonidine can help with autonomic symptoms, but it is generally used as an adjunct rather than as the sole treatment. If no pharmacologic treatment is used, infants with significant NAS symptoms do not receive evidence-based care for withdrawal.

So the statement that oral morphine solution and methadone are supported when pharmacologic treatment is indicated aligns with current evidence and practice.