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In this issue, Hamilton et al1 and Gupta et al,2 from two different Scottish centres, describe the ocular findings in cohorts of children who had been exposed to opiates, including methadone, or benzodiazepines in utero. Both groups make compelling arguments for opiate use, and possibly benzodiazepine use, resulting in visual pathway and visuomotor abnormalities with one group utilising visual electrophysiology. Gupta et al go so far as stating that “…we must conclude that these substances have teratogenic effects alone and particularly when used in combination”.
The teratogenic effect of opiates in animal models (namely diamorphine hydrochloride, methadone hydrochloride and the synthetic enkephalin analogue FK 33-824) was first observed in 19853 and included a neurotropic syndrome of malformations restricted to the central nervous system if administered during the critical period of neural tube closure. Pretreatment with corresponding equimolecular doses of the antagonist naloxone hydrochloride …