Taking Suboxone During Pregnancy: Is It Really Safe?
Updated: 3 days ago
"Is taking Suboxone while pregnant safe?" is a common question I get asked. For the expectant mother, it is a decision that requires careful consideration of both risks and benefits. Pregnancy is both a hopeful and challenging time, especially for women with substance use disorders. Ongoing opioid addiction poses significant risks, but so does withdrawal and relapse. Suboxone offers a way to treat opioid use disorder that can lead to improved outcomes for both mother and child.
I wrote this guide for my patients who are expectant mothers with opioid use disorder. This provides everything they need to know about using Suboxone, or Subutex, as a form of medication-assisted treatment during pregnancy. For my patients who are at the methadone clinic, I have an upcoming guide that discusses medication assisted treatment using methadone during pregnancy.
This evidence-based article explores important topics like the effects of prenatal Suboxone exposure, proper dosing, breastfeeding recommendations, and more. This information is so important that I decided to share it with everyone.
After reading, expectant mothers will be empowered to have informed conversations with their healthcare providers about this important treatment option. And if I am so lucky to be their doctor, they will feel free to discuss questions with me. The goal is to provide the facts needed to make the best choices for themselves and their babies.
What is Suboxone and How Does it Work?
Suboxone is a prescription medication used to treat opioid addiction. Suboxone contains two active ingredients:
Buprenorphine - A partial opioid agonist. It activates opioid receptors enough to prevent cravings, withdrawal symptoms, and pain without creating a full "high".
Naloxone - An opioid antagonist. It blocks opioid receptors and reverses overdose effects.
When taken properly (dissolved under the tongue), the naloxone in Suboxone has very low absorption and the primary active ingredient is buprenorphine. The addition of naloxone helps prevent Suboxone abuse via IV injection.
Suboxone works by binding to and activating opioid receptors in the brain enough to ease withdrawal symptoms, reduce cravings, and normalize brain function. This allows people dependent on opioids, like heroin or prescription painkillers, to discontinue illegal drug use and stabilize their lives.
Why Consider Suboxone Use During Pregnancy?
Untreated opioid use disorder during pregnancy can have devastating effects on both mother and child. Continued opioid abuse is associated with:
Neonatal abstinence syndrome (NAS)
Blood borne diseases (HIV, Hepatitis B and C)
Potential lost custody of the baby
NAS is a group of complications newborns experience after chronic opioid exposure in utero. Symptoms of NAS include excessive crying, fever, diarrhea, vomiting, failure to eat, seizures, and even death in severe cases.
Medication-assisted treatment with Suboxone helps avoid these negative outcomes. It allows pregnant women to stop using dangerous street drugs by managing withdrawal and cravings. Benefits of suboxone treatment:
Improved prenatal care
Reduced risk of infections like HIV and hepatitis
Stable fetal growth and development
Lower risk of preterm birth or stillbirth
Milder NAS symptoms in newborns
The benefits of treatment greatly outweigh the risks of continued opioid abuse during pregnancy.
Is Suboxone Safe in Pregnancy?
Suboxone is considered relatively safe during pregnancy, especially compared to the alternatives. The FDA categorizes it as pregnancy category C, meaning:
Animal studies show no fetal risk
There are no human studies demonstrating safety
Potential benefits may justify use despite unknown risks
Small studies of Suboxone in pregnancy show outcomes similar to methadone, which is an accepted standard of care for pregnant women with opioid use disorder. Larger studies are still needed to fully establish long-term effects, but current data supports Suboxone as one of the safer options available.
When used properly, the amount of naloxone in Suboxone reaching the bloodstream and crossing the placenta is low. The primary concern is neonatal exposure to buprenorphine, which appears relatively mild. Current studies show no difference in outcomes whether mothers use Suboxone (bupreorphine-naloxone) or Subutex (buprenorphine).
What Are the Effects of Suboxone on Babies?
The active ingredient buprenorphine easily crosses the placenta during pregnancy. This means newborn babies will likely exhibit symptoms of Opioid withdrawal known as neonatal abstinence syndrome (NAS). Possible NAS effects include:
The difference is babies exposed to Suboxone appear to have less severe NAS symptoms that are easier to treat compared to methadone. They exhibit fewer tremors, restlessness, respiratory issues, and feeding problems. NAS onset may also be delayed.
This allows many newborns to be successfully managed without medication, through supportive measures like swaddling, skin-to-skin contact, and breastfeeding. Those requiring treatment generally need shorter hospital stays, lower medication doses, and less time to wean off drugs.
What Are the Recommended Suboxone Doses in Pregnancy?
The goal with Suboxone treatment is to use the lowest effective dose needed to manage withdrawal symptoms and cravings. Dosing must be individualized for each patient.
Pregnant women often need slightly higher doses to feel stable, especially in the 3rd trimester as blood volume expands. It is unsafe to abruptly stop Suboxone due to high relapse risk, withdrawal symptoms and potential miscarriage.
Suboxone doses in pregnancy typically range from 4-32 mg per day, with an average of 16 mg. Dosing varies based on factors like:
Previous opioid abuse patterns
Metabolism changes in pregnancy
Concurrent drug use
More significant opioid addiction, such as fentanyl abuse, typically requires higher doses. Some doctors lower the dose gradually near the due date to reduce newborn exposure. However, I believe doing so is a very bad idea. Tapering during pregnancy puts the expectant mother at high risks for relapse, overdose, and spiraling out of control. I remember one important saying during my obstetric anesthesia training, "take care of mom and you take care of baby."
What Else Should I Know Before Taking Suboxone While Pregnant?
Inform your provider about any other medications, drugs, supplements or herbs taken during pregnancy - even occasionally. Dangerous interactions may occur.
Heavy alcohol use should be avoided, as it increases the risk of miscarriage and certain birth defects.
Bloodwork helps monitor liver health. Testing for hepatitis B/C, HIV and other infections is important.
Counseling, support groups, prenatal education, and case management lead to better outcomes. A team-based treatment approach is ideal.
Have a mentor or join a Facebook group for expectant mothers taking Suboxone or Subutex
Breastfeeding provides many benefits and is encouraged for mothers on stable Suboxone doses. Compared to mothers, breast milk will contain 1-2% of the buprenorphine levels found in the mother.
Help for stabilization, housing, transportation, and other basic needs improves compliance with prenatal care and Suboxone treatment.
Honesty about relapse and any continued drug use allows proper medical management to reduce risks. The goal is a healthy pregnancy, not punishment.
What About Heroin, Fentanyl, and Other Opioids?
The street opioid supply has never been more dangerous. Heroin is routinely mixed with or replaced by fentanyl - an opioid 50-100x more potent. Fentanyl rapidly crosses the placenta and causes extreme NAS. Plus, xylazine (tranq) is a frequent adulterant in heroin and fentanyl. I have written a blog post warning of the risks of xylazine. Pregnant women face high overdose risks using unknown and fluctuating purity of opioids acquired illegally. Suboxone offers a much safer alternative, allowing known doses of a medication prescribed under medical supervision.
No opioids are completely "safe" during pregnancy. However, the risks of uncontrolled heroin and fentanyl abuse far outweigh those of Suboxone treatment with prenatal monitoring.
For pregnant women struggling with opioid addiction, Suboxone offers hope for healthier moms and babies. While not risk-free, it empowers women to take control of their health and improve the lives of their families.
My Experience Treating Pregnant Patients
First, I have to say that I have been honored by the expectant mothers who chose me for their care. I am fortunate to be an anesthesiologist and an addiction doctor. I've had plenty of opportunities to provide medication-assisted treatment during the pregnancy, labor epidural placement during the hospital stay, and then postpartum MAT when patients are discharged from the hospital. I've seen nothing but positive outcomes when Suboxone or Subutex have been used throughout the pregnancy. Also, I've aligned myself with several obstetricians in the Tulsa area who are heroes when it comes to treating pregnant patients who are recovering from substance abuse.
I am Here to Help
I lead a team with decades of experience, and a commitment to providing you with comfort, care, and respect as you navigate this challenging time in your life. We also make treatment super convenient with hours of operation that extend from 0800 AM to 0900 PM, 7 days a week through scheduled appointments, accept most insurances and make addiction treatment accessible to practically all who call 918-518-1636. We are conveniently located in Tulsa, Oklahoma, and The Woodlands, TX. We are waiting for your call.
In Summary: Key Points for Pregnant Women Considering Suboxone
Untreated opioid addiction during pregnancy is very high risk to mom and baby - the benefits of treatment outweigh the risks.
Buprenorphine during pregnancy is safe during pregnancy when monitored by physicians.
Suboxone enables opioid cessation and recovery by easing cravings and withdrawal.
Buprenorphine in Suboxone crosses the placenta, but appears safer than alternatives.
Babies exposed to Suboxone typically have milder NAS that is easily manageable.
Work closely with your OB provider or addiction medicine specialist to determine the optimal Suboxone dose for each pregnancy stage.
Be honest about any continued drug use to allow for proper medical care.
Take advantage of support services to help your treatment journey.
Breastfeeding is encouraged for most moms on Suboxone.
Discuss this information and your options thoroughly with your healthcare provider. Make informed choices to provide the best possible care for your baby and yourself.
This article is for informational purposes only and does not constitute medical advice. Please consult your physician before making any decisions about Suboxone treatment during pregnancy.
Frequently Asked Questions
Q: Is it safe to take Suboxone during pregnancy?
A: Taking Suboxone, which contains buprenorphine and naloxone, during pregnancy is safer than using street drugs. It's a decision I highly encourage you to talk with your doctor.
Q: Can pregnant women with opioid addiction use Suboxone?
A: Yes, pregnant women with opioid use disorder can use Suboxone or Subutex. Buprenorphine is the active ingredient that controls cravings and withdrawal.
Q: What are the effects of Suboxone use during pregnancy?
A: Suboxone use during pregnancy can potentially stabilize the mother's opioid use disorder. This creates a healthier environment for the developing fetus. Discuss the risks and benefits with a healthcare professional.
Q: Is Suboxone treatment during pregnancy safer than other options?
A: Suboxone treatment is considered one of the safer options for pregnant women with opioid use disorder. Medications like Suboxone can minimize the risk of relapse and make recovery easier to manage.
Q: Are babies born to mothers on Suboxone at risk of neonatal abstinence syndrome (NAS)?
A: Babies born to mothers using Suboxone may still be at risk of developing neonatal abstinence syndrome (NAS). NAS occurs when a baby is exposed to opioids during pregnancy and experiences withdrawal after birth. However, the severity can often be lessened through proper management and medical support.
Q: Is Suboxone safe when taken by pregnant women?
A: Suboxone is classified as FDA Category C, indicating that it may have risks during pregnancy. However, it is always best for expectant mothers to seek addiction treatment. Consultation with a healthcare professional is essential in determining the most appropriate course of action.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.