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Doctor’s Note: Medicated Withdrawal from Fentanyl in a High-Risk Pregnancy
TO WHOM IT MAY CONCERN: Ms. Walters was admitted into our facility on 06/14/2025 for medicated withdrawal from fentanyl during pregnancy. Mrs. Walters and fetus both showed severe signs of dependence on fentanyl. During Ms. Walters’s inpatient treatment, we were able to provide methadone to stabilize her withdrawal symptoms with a split dosage of 180 mg methadone during the AM and 90 mg methadone during the PM.
The purpose of this document is to provide a detailed account of Ms. Walters’s clinical presentation, treatment regimen, and follow-up recommendations in the context of her high-risk pregnancy. It is intended for healthcare-related recipients, including obstetric and addiction specialists, to ensure continuity of care and to support her ongoing prenatal management.
1.2 Overview of patient case
Ms. Walters, a pregnant patient with documented fentanyl dependence, underwent an inpatient medicated withdrawal protocol at Swedish Medical Center. Admission occurred on June 14, 2025, and discharge followed on July 2, 2025, upon successful stabilization. This overview sets the stage for further examination of her background, clinical signs, and treatment outcomes.
2. Patient Background
2.1 Patient demographics and medical history
Ms. Walters is a 30-year-old female currently in her thir trimester of pregnancy. She has a history of opioid use disorder, specifically chronic fentanyl use over the past year, and no significant comorbidities documented prior to this admission. Her medical records indicate intermittent prenatal engagements before presenting for withdrawal management.
2.2 Pregnancy status and high-risk considerations
At admission, Ms. Walters was approximately 30 weeks gestation. Fentanyl exposure during pregnancy places both mother and fetus at risk for withdrawal syndromes and obstetric complications such as preterm labor, intrauterine growth restriction, and neonatal abstinence syndrome. Careful coordination between addiction medicine and obstetrics is critical for optimizing maternal–fetal outcomes.
3. Clinical Presentation
3.1 Signs and symptoms of fentanyl dependence
Prior to admission, Ms. Walters exhibited classical signs of opioid withdrawal, including tachycardia, diaphoresis, restlessness, nausea, and moderate to severe cravings. Physical examination also detected hyperreflexia and mydriasis, consistent with acute opioid cessation. Baseline fetal monitoring revealed increased fetal movement patterns suggestive of withdrawal stress.
3.2 Assessment on admission (06/14/2025)
On June 14, 2025, Ms. Walters presented hemodynamically stable but symptomatic, with a Clinical Opiate Withdrawal Scale (COWS) score of 16, indicating moderate withdrawal. Fetal assessment via ultrasound demonstrated appropriate biophysical profile, but signs of increased fetal irritability were noted. Laboratory studies were within normal limits for hepatic and renal function.
4. Treatment Regimen
4.1 Medicated withdrawal protocol
The inpatient protocol followed standard guidelines for opioid agonist therapy during pregnancy, emphasizing gradual titration and splitting doses to minimize peak-trough fluctuations. Multidisciplinary care included obstetric surveillance, nutritional support, and psychosocial counseling to address addiction behavior and prenatal health.
4.2 Methadone dosing schedule (AM 180 mg / PM 90 mg)
Ms. Walters received a split methadone dosage, with 180 mg administered each morning and 90 mg each evening. This regimen was maintained throughout her inpatient stay, providing consistent opioid receptor occupancy and relief of withdrawal symptoms.
4.3 Monitoring and adjustments during inpatient stay
Daily monitoring included COWS assessments, vital signs triage, and weekly obstetric evaluations. Methadone dosing was adjusted by no more than 10 mg per dose based on withdrawal severity, with close observation for signs of over-sedation. Fetal heart rate monitoring was performed bi-daily to ensure continued fetal well-being
5. Outcome and Discharge
5.1 Completion of withdrawal treatment
By July 2, 2025, Ms. Walters achieved stable opioid agonist levels without significant withdrawal symptoms, meeting discharge criteria for inpatient medicated detoxification.
5.2 Discharge details (07/02/2025)
Ms. Walters was discharged from Swedish Medical Center on July 2, 2025, with instructions to continue methadone therapy on the established split dosing schedule, with the option to increase dosage if clinically indicated. A high-risk prenatal care plan was arranged, including bi-weekly obstetric visits and coordinated addiction support services.
6. Ongoing Management and Recommendations
6.1 Continuation and potential escalation of methadone
Post-discharge, it is recommended that Ms. Walters maintain her current methadone regimen, with dose adjustments guided by withdrawal symptoms and fetal monitoring results. Escalation should not exceed 5–10 mg increments per week, under careful supervision.
6.2 Follow-up prenatal care plan for high-risk pregnancy
A structured follow-up plan includes obstetric ultrasounds every four weeks, non-stress tests and ongoing psychosocial support for addiction management. Collaboration between the maternal-fetal medicine team and addiction specialists is essential to monitor fetal growth and maternal health parameters.
7. Conclusion
7.1 Summary of treatment efficacy
Ms. Walters’s inpatient medicated withdrawal was effective in stabilizing opioid dependence, alleviating acute withdrawal symptoms, and maintaining fetal safety. The split methadone regimen provided adequate receptor coverage with minimal sedation or adverse effects.
7.2 Final remarks and certification
I, Dr. A. Smith, hereby certify that the information provided in this report accurately reflects Ms. Walters’s admission, treatment course, and discharge plan. This document is intended to guide her ongoing care through specialized obstetric and addiction services