Ask an Expert: Is Suboxone Safe for Pregnant Women?

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Ask an Expert: Is Suboxone Safe for Pregnant Women?

By Howard C. Wetsman MD 01/02/17

If you have addiction, it's important to be in treatment during pregnancy and to have an addiction medicine physician as part of your pregnancy team. 

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I'm in a buprenorphine group and there are a lot of pregnant women and women who gave birth while on the drug. Some were saying that their doctors would switch them to pure buprenorphine when they got pregnant, but otherwise they had to take Suboxone with the naloxone. Is there a best practice in the use of buprenorphine during pregnancy?  

Howard Wetsman, MD: That's a great question and the answer is evolving. The gold standard treatment for opioid dependent women who become pregnant was methadone maintenance. This was primarily to avoid the intrauterine withdrawal for the fetus necessary to start buprenorphine. Recently, the MOTHER (Maternal Opioid Treatment: Human Experimental Research) study, showed that it is quite possible to treat pregnant women with buprenorphine. But again, worry about withdrawal for the fetus has led most to be concerned that we use only buprenorphine mono-product (without naloxone) instead of buprenorphine/naloxone combination. There is a tension between wanting not to hurt the fetus, so avoiding even the remotest possibility of withdrawal and thwarting diversion so as to help more people getting treated by knocking down societal barriers to treatment. One side would use buprenorphine mono-product and the other, the buprenorphine/naloxone combination. 

The current official recommendation is to use the mono-product, but more and more recent studies have shown that the danger of using buprenorphine/naloxone is not as great as we thought. The bottom line is that each case is different, with different risks and different considerations. If you have addiction, it's important to be in treatment during pregnancy and to have an addiction medicine physician as part of your pregnancy team. You and the team can come up with an approach tailored to your particular case.

Howard C. Wetsman, MD, is the Chief Medical Officer and Founder of Townsend. A board-certified psychiatrist and Addiction Medicine Specialist, he is responsible for overseeing all aspects of outpatient addiction treatment within Townsend’s seven clinic locations. Full Bio.

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