Category: Fertility Treatments

Submitted by: Richard Senyszyn

Opioid Maintenance In Pregnancy : Information for Patients and Providers

There are several options for treatment of opioid addiction during pregnancy. The ones of importance include: methadone in pregnancy, Suboxone (buprenorphine/naloxone) in pregnancy, and buprenorphine alone during pregnancy. This is an important topic for mothers who have an opioid addiction and face the choice of whether to continue their opioid maintenance treatment during their gestation or whether to discontinue the medication. As always, only individualized treatment with your own physician can adequately assess your situation and the following are general guidelines.

The current thinking for mothers with an opioid addiction is to continue their maintenance medications.

Suboxone carries a Pregnancy Category C indication by the FDA which means that a risk to the fetus can’t be ruled out. Since Suboxone is a combination of buprenorphine and naloxone, mothers are many times switched to buprenorphine alone (Brand name Subutex) to decrease exposure to one medication rather than two.

There are a number of risks to discontinuing the methadone, Suboxone, or buprenorphine. The main concern is the risk of the mother going back to using illicit drugs. If this happens, the fetus will be exposed to cycles of the mother getting on and off the drug based on what they can obtain on the streets. The fetus may also get exposed to HIV as drug use and promiscuity are related. The mother is less likely to receive proper healthcare for herself or the fetus, resulting in premature birth, low birthrate children, and the possibility the child will be removed from the home eventually.

It is believed that because of these risks, the majority of opioid dependent mothers should maintained on their medication through pregnancy and after. There there is a 30-40% chance the newborn will undergo an abstinence syndrome at birth, but this is easily managed with proper warning to the treatment team before the birth. Buprenorphine appears to carry a lower risk of neonatal abstinence syndrome compared to methadone. Since there is minimal drug in the breast milk, mothers are allowed to breastfeed.

The American Psychiatric Association sponsors webinars on buprenorphine treatment and the latest update on pregnancy can be viewed here. The webinars are primarily designed for healthcare providers, but have great value in answering questions about Suboxone and Buprenorphine to the person who is taking or is considering taking Suboxone (buprenorphine/naloxone) during pregnancy.

I found this lecture on pregnancy very helpful from a medical perspective. Providers of Suboxone in pregnancy will find the information in the lecture invaluable. The lecture is clear, to the point, and contains updated information on prescribing Suboxone in pregnancy. I think the video could easily be understood by most anyone.

What If One Still Wants To Get Off Their Maintenance medication despite the risks?

Getting off a opioid maintenance regimen is a big deal, let alone to a pregnant mother. It should involve at the very least one physician who can monitor the one’s progress. A pregnant female should not rush to get off the medication without professional assistance. I have seen patients alarmed by their pregnancy who get off their medication without a proper discussion. They usually end up wanting to get back on their medication to remain stable.

It is thought that if one is going to wean from the medication, it should be done prior to 32 weeks pregnancy. This will prevent complications of withdrawal (premature baby) prior to the planned delivery date. After delivery, one should consider with their physician, getting back on the maintenance medication as quickly as possible. Preferably immediately.

Opioid Maintenance and Pregnancy : Other Points

– Follow up with your physician every one to two weeks.

– Continue drug counseling during pregnancy.

– It is common to need an increase in the Suboxone, Methadone, or buprenorphine during pregnancy. Expect about a 25% increase in dose.

– Epidural analgesia is effective while on maintenance therapy during pregnancy.

– Nalbuphine and Butorphanol are contraindicated while on maintenance treatment during pregnancy as both can precipitate withdrawal.

– IV and oral narcotics are used to supplement the maintenance dose of methadone, Suboxone, or buprenorphine during labor.

– breastfeeding is recommended unless HIV positive.

– There appears to be a problem with medication compliance with mothers at about 3 months post partum. Prepare for this possibility.

– There is almost always more of a benefit in having the pregnant mother quit smoking than to get off the methadone, Suboxone, or buprenorphine in pregnancy.

Opioid Maintenance In Pregnancy : Summary

Mothers on opioid maintenance treatment should usually continue their treatment during pregnancy and after delivery. The risk of weaning from maintenance opioid treatment is usually greater than continuing treatment. The mother can best benefit by quitting smoking and receiving proper prenatal monitoring to have the best chance of a good outcome.

About the Author: Dr. Rich (Richard Senyszyn MD) is a Board Certified Psychiatrist who has an interest in addiction treatment. For more information on Dr.Rich, Suboxone, and finding a doctor who prescribes Suboxone near you:

Suboxone Clinics Directory

. Dr. Rich also writes on other addiction topics including alcoholism and where to find alcohol treatment at

Alcohol Treatment Directory

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