NAS: Subutex, Suboxone & Methadone In Pregnancy

Every mother wants what's best for her unborn child. Sadly many mothers find themselves in the situation where they required the use of Methadone or Buprenorphine during their pregnancy. Despite the common mythconception, this is not always the result of illicit drug abuse - there are many cases of dependancy caused by the result of legitimate treatments fully supervised by Doctors. Regardless of the reasons why a mother find herself in this situation, it is of the utmost importance that she works closely with medical professionals to make well informed decisions about the welfare of her unborn child...and she do this as early as possible.

To this effect, this hub has been written to help mothers and their families to understand the information about Methadone or Buprenorphine during pregnancy - not just the dangers, but how these drugs work and why early medical attention is necessary. This hub has a companion - NAS: Neonatal Abstinence Syndrome - which will also be beneficial read to those dealing with substance use or abuse during pregnancy.

I dedicate this hub to all those wonderful professionals who work without judgement to bring so many of these NAS babies safely into the world and who work with the families to provide the long term care and support that is needed. Kudos to you!

Make a well informed decision with your Doctor.
Make a well informed decision with your Doctor.

Methadone Subutex Soboxone - Drug Use In Pregnancy

Regardless of how mothers find themselves in the situation, it is vital to make a well informed decision as to how to proceed with treatment. There are three main drugs that are used to treat drug dependency. Methadone, Buprenorphine and Naltrexone. To give you an idea of how these drugs will affect your unborn child, you need to understand how they affect you.

Methadone - Agonists are drugs that stimulate the opiate receptors in your brain - easy to remember...they cause you agony if you stop using them abruptly! Agonists include Heroin, Morphine, Benzodiazapines, Methodone etc.The use of Methatdone during pregnancy has been well documented and it's use is deemed as "safe." However there are better options available today.

Naltrexone - Antagonists are drugs that coat the receptors in the brain and prevent them from receiving the stimuli from agonists.

Buprenorphine - Subutex and Suboxone both contain Buprenorphine - it's the active ingredient on which they are based. Suboxone can be regarded as Subutex Plus (for it contains some extra ingredients that prevent it's misuse - naloxone). Buprenorphine is a partial agonist. It coats the receptors in the brain whilst allowing a small amount to pass through thus keeping withdrawals at bay.

To put it simply:

Agonists = the door is wide open

Antagonists = the door is closed and locked

Partial agonists = the door is left ajar.


You wouldn't risk your baby's health if you could see him...
You wouldn't risk your baby's health if you could see him...

So what's best for baby?

Up to 94% of babies born to opioid dependent mothers exhibit signs of NAS so it's vital that mothers seek early antenatal care. It's the general consensus that antagonists should not be started during pregnancy as sudden withdrawal from any drugs can cause seizures, premature delivery or even the death of the fetus.

Recent studies (May 19, 2010 (San Francisco, California) have shown that Subutex is safer for neonates than methadone which has been used traditionally. In addition, being a partial agonist, Buprenorphine withdrawals are milder. The additional ingredient Naloxone which is found in Suboxone can cause seizures and other problems in neonates therefore Subutex is currently the number one choice by Doctors.

Subutex is a relatively new drug. It is a C class drug which means the manufacturers do not recommend it's use during pregnancy...this is a precaution all drug manufacturers take to protect themselves from future law suits.

Since it is unethical to conduct drug trials on unborn children, the only data available is that which has been gathered from mothers who volunteer for drug surveys. So far, Subutex has been considered most favourably and thousands of baby's have arrived safely without long term complications.These children have yet to grow old though and the continual studies of their health is of great interest.

In contrast, Methadone has been used to treat opioid dependency for over 40yrs - thousands of Methadone babies have grown to have no/low occurrence of long term issues. However, Methadone, being an agonist (an opioid) does cause high occurrence of NAS.

In short, those Subutex babies that do show signs of NAS experience milder withdrawals. Those who require hospitalization will stay for less time than those born to opiate dependent mothers and require less medication. You can find more info here.

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The Bad News vs The Benefits...

The use of any drugs including those found in your supermarket or pharmacy carries certain risks. A drug is deemed safe when the risks cause minimal long term damage, when the risks occur in a minute percentage of patients and when the benefits outweigh the dangers of not treating the injury, illness or addiction.

Your Doctor will inform you of the many dangers associated with the use of Methadone or Buprenorphine during pregnancy including premature birth, placental abruption, IUGR (Interuterine Growth Restriction), fetal loss, malformations and a whole host of other complications. These risks are small...but they are present. Please keep in mind these problems also occur in drug free pregnancies and are no reason to cease your treatment - the risks are higher if you continue to use drugs instead of these treatments.

Over half of neonates who are exposed to Buprenorphine in utero during pregnancy will experience NAS. About 40% of Buprenorphine babies will require treatment. Don't be put off though, approx 36% of Subutex babies experience no signs of withdrawal (a figure that was only dreamt of decades ago) and the percentage of Methadone or opiate babies who experience NAS much higher in comparison. Please read here for more details about NAS.

Many of these problems occur in a small percentage of births but the fact is the risk is increased. The benefits of using these drugs must therefore outweigh the dangers? They do.

  • Mothers are less likely to overdose on a prescribed medication.
  • Mothers are maintaining a consistent level of the drug in their bloodstream - fluctuations can trigger the early onset of labour or miscarriage.
  • Mothers are using a regulated drug as opposed to street drugs which also contain other harmful ingredients.
  • Mothers are less likely to continue using drugs/alcohol.
  • There's a decreased likelihood of mothers sharing injecting equipment and exposing themselves and their baby to blood born virus's like Hepatitis or HIV
  • Only 64% of Buprenorphine babies experiense NAS as opposed to 94% of babies born to opioid dependent mothers. Not all of these babies will require treatment.
  • 36% of Subutex babies experience no symptoms of NAS
  • Subutex is a partial agonist which means the withdrawals are milder than other opiates and methadone.
  • Subutex neonates require less medication and and have shorter stays in hospital.

Breast Feeding and Subutex

For all the potential that Subutex is showing, there is still a hesitancy to approve the use of Subutex whilst breast feeding. Again, this is a precaution that every pharmacutical company takes in an effort to spare itself future embarrassment.

For more information about the arguments for and against the use of Buprenorphine during lactation please read NAS: Neonatal Abstinence Syndrome


The veil between Doctor's and patients needs tearing down.
The veil between Doctor's and patients needs tearing down.

Final Thoughts

NO medical decisions should be made without the consultation of your Doctor. You should not cease the use of Methadone, Suboxone or Subutex.

Some mothers may be inclined to conceal drug/alcohol dependency from their medical professionals for a number of reasons...usually involving their ego. There is a veil of secrecy between pregnant patients with drug dependencies and their Doctors - it needs to come down. Help break the stereotype and be a good Mum...tell your Doctor.

For an overview of NAS and it's treatment please click here to read this articles sister called NAS: Neonatal Abstinence Syndrome.

For a supportive ear...

As a temporary solution to my flooded Inbox, I have created a forum for mothers and their families to come and ask questions or share experiences about using Buprenorphine during pregnancy and breastfeeding.

I'd like to invite you to come and visit...but more importantly CONTRIBUTE to this forum.

Click to visit the Subutex Babies Forum


Please address you mail to eliz.nesbitt@gmail.com

The use Buprenorphine (Subutex & Suboxone) or Methadone during pregnancy is a complex issue and there is lotsof conflicting advice. I have created this email for mothers and families who wish to contact me privately about their specific situation.I will be happy to share the additional information I have learned that is not discussed in this hub and answer private emails about the use of Buprenorphine and Methadone during pregnancy and lactation or about beginning Subutex treatment in pregnancy.

More by this Author


Share you're experiences, your thoughts and your queries about Methadone or Buprenorphine in pregnancy 6 comments

Mel 4 years ago

I am currently on Methadone, NOT pregnant, but I am yearning to have another child, I had my first and only daughter way before methadone came into my life & that experience was hard enough, I am just so worried about bringing a child into the world & it's first few days of being born will be agonizing. I'm not sure if I could live with the guilt, especially if something went horribly wrong. Another problem is, no one in my family knows I'm on methadone except for my husband. So that would be tough explaining why my baby had to stay in the hospital after I come home. So unfortunately it feels like I can't have another child due to my own stupidity.


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Artist-For-Hire 4 years ago from Western Australia Author

Honestly... NAS is very manageable as long as you tell your OB & Paed's about it. Subutex/Suboxone withdrawals are rarer and milder than methadone or opiate withdrawals so there's always a chance (on a lowish dose) that your baby will come home with you.

Ultimately, it's something to talk about with your prescribing Doctor - make sure you know what you're getting into and you're well prepared.

And in regards to explaining things to the family... babies can develop NAS from some types of anti-depressants...


amanda 4 years ago

West Warwick, RI

1 min ago

Just to shed some light on this contraversial subject of pregnant moms using the drug Suboxone during pregnancy.My plan had been to get off the drug prior to pregnancy.I already had a 4 year old son at the time and was trying for 2 years prior to get pregnant. However, when i discovered i was pregnant i instantly called my Sub doctor, went online, and continued to research the potential ill effects to my unborn child. However, after doing all research every conclusion was the same,i was more at risk of miscarrying the baby then if i stayed on the drug and monitored by the Sub doc and my OB GYN.It was so hard though because even though my husband is also on the drug, our families did not know that i was taking it.We decided not to tell our families for privacy reasons and it devastated them originally when my husband was an addict so we didn't want to trudge those feelings up again. I felt extremely ashamed all pregnancy but knew that i had made the right choice. Everything went very well, i had my beautiful,healthy, baby girl in November of 2011.However, im writing in this forum today because i needed to share my experience and warn others so that hopefully another mom who has to take Suboxone has knowledge on her side. During the pregnancy i was never really prepared by my docs about what the course of events would be like after i gave birth. I was aware of risks of the baby having withdrawal s/s but no one ever explained any procedures to me or the extent of withdrawal symptoms, nor did i know that i would most likely have to leave my daughter there.I had a c-section with both my kids, however, this one was much more painful. I honestly felt so scared and alone because i felt judged at the hospital by the staff because of the drug i was taking (even though im a nurse myself). Also,no one, i felt, was prepared to treat my post c-section pain. I was in the most severe pain in my life and was being looked at like a scumbag because i needed a more appropriate pain med plan.I had a PCA with morphine but anyone that knows about suboxone (actually MD switched me to subutext while pregnant cause it has no narcan)knows that it blocks pain meds from having an effect.I actually asked them to call my sub MD for a better plan and no one ever did. Anyways, after about 48 hrs. my baby started to withdraw.They use a scale called

finnegans to score and see the level of withdrawal that the baby is having.After an 8 on the scale the doc told me they were putting the baby on Phenobarbital and then probably morphine which is then slowly tapered off (very slowly) and only after a couple days of positive effects. I had no idea about this process and was not prepared mentally for it. Also, my husband and i had to scramble to explain to our 2 very involved sides of the family why our otherwise healthy baby could not potentially be home for 3 to 4 weeks-awkard! We had to lie and say she wasn't eating well and they were running tests. It was true she wasn't eating well, developed jaundice, and was tremoring,but of course due to withdrawal symtoms. Eventually our families became suspicious because the hospital staff was awkward and very secretive almost stand-offish when our family was in the room. Plus they had to come in like every hour and take the baby to the nursery to give her her morphine and phenobarb and do the finnegans scoring. Thank god after 2 weeks of my leaving the hospital (she was in a total of about 3 weeks) she was detoxed completely off morphine and sent home with us but still on phenobarb. It was one of the happiest moments of my life but those two weeks waiting for her were very sad,lonely,frustrating, and depressing. My family was very worried i was going to have post partum depression but honestly the whole experience took a couple months to impact me. I just wanted to educate other families/women going through this experience because knowledge is power, and i want women to prepare themselves for this experience,Good luck moms!


Sam 4 years ago

Just found out I was with child and and taking subs and will change to subutex... Or should I quit everything I am only six weeks help


Kathy 4 years ago

I just found out my daughter is pregnant....she is on methadone...they said she would have to change over to suboxone..that's the drug they choose..if anyone has info about changing drugs during 1st trymester...what r the risk fot the mothers and the babie..do u have to detox off methadone befor starting the other drug....i have scene so many articals ....if anyone knows please gelp me...she has waited 7 years for this baby......


rose 3 years ago

I am 27 weeks. I have been taking xanax that are presribed that my doctor knows about, but I also have been taking suboxone the whole pregnancy but I have not told my ob b/c I'm scared I will get dss called on me and go to jail. A friend of mine just had a baby this past june. She was on cocaine, crack, weed, xanax, and all kind of pain pills. So when she went to have her baby they drug tested her and the baby, they both had all the drugs in their system. So they locked the girl up for child neglect. She got 4 years. So iim so scared that will happen to me. My doctor did tell me to stay on the xanax b/c it may harm the baby if I stop. Please someone give me some answers????

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