Pregnant or Breastfeeding? Buprenorphine, Suboxone, Subutex or Methadone - Safe for Baby and Mom During Pregnancy?
Is Suboxone safe for use during pregnancy? Will Suboxone cause NAS (infant withdrawal symptoms)? Is Suboxone better than methadone for use during pregnancy?
If you are pregnant and addicted to opiates, you have 3 choices:
- Keep abusing your drug of choice
- Try to quit using and suffer through withdrawal and detox
- Get into an opiate substitution program and use methadone or Suboxone
The first 2 choices are not advised. Continuing to abuse drugs subjects the fetus to a lot of environmental risks, disease and to a reduced likelihood that the mother is going to take good care of herself during the pregnancy.
Trying to quit cold turkey and going through a hard withdrawal is also very risky. Opiate withdrawal is tough on the body, and the risk of miscarriage during a period of withdrawal is also very high.
This leaves getting on methadone or Suboxone as the only alternative remaining.
Is Buprenorphine Safe During Pregnancy?
At present, Buprenorphine is listed as a category C drug for use during pregnancy. This, in the case of Suboxone, means that although scientists think it's probably OK – enough study has not yet been done proving that this is so (the manufacturer does not recommend that it be used during pregnancy).
Methadone has been studied very extensively for use during pregnancy and has been proven safe for both the mother and fetus – and thus the accepted protocol is to recommend that pregnant women take methadone instead of Buprenorphine.
Pregnant women who cannot or will not take methadone may be advised to take buprenorphine instead. Although doctors cannot say with absolute certainty that buprenorphine is safe, the available evidence indicates that it is not harmful to the mother or fetus, and if the mother cannot or will not take methadone, buprenorphine is likely preferable to no treatment or a cold turkey detox.
Suboxone is a medication that contains buprenorphine and Naloxone. The naloxone is added to the buprenorphine to lessen the odds that a user will abuse the medication. Because Naloxone can sometimes cause symptoms of opiate withdrawal, pregnant women wanting to take buprenorphine are normally advised to take Subutex instead. Subutex is exactly the same as Suboxone, but it contains no Naloxone, only buprenorphine.
If a women becomes unexpectedly pregnant while taking Suboxone – her doctor will probably recommend that she switch to Subutex, but not switch to methadone or any other form of treatment. Switching after she is already pregnant carries an unacceptable risk of stress on the fetus. If a woman plans on becoming pregnant, her doctor will likely advise that she first switch to methadone or naltrexone before getting pregnant.
Does Subutex Cause NAS (Neonatal Abstinence Syndrome)
If you take Subutex while pregnant, your baby will be born addicted to buprenorphine, and will likely go through some degree of NAS.
Studies indicate that over half of babies born to Subutex using mothers will suffer this infant withdrawal period to some degree. Many infants with NAS need only a few days of additional cuddling, attention and quiet – some infants will need treatment, such as with an opiate tincture.
The likelihood or severity of NAS in babies born to methadone using women does not seem to be influenced by the dosage that she was on. Therefore, with methadone at least, women are not recommended to attempt to reduce their dosage drastically in an attempt to spare their baby NAS. Quick reductions in dosage are associated with miscarriage inducing withdrawal and a higher risk of relapse back to a drug of abuse.
Is Methadone better than Subutex During Pregnancy?
Methadone has been very well studied for a long period of time, and it is known to be safe for both the mother and unborn child.
Preliminary studies of buprenorphine indicate that it is also safe, but there is not yet sufficient clinical evidence to allow for a recommendation of use.
Several studies that have compared methadone and buprenorphine use during pregnancy indicate that the NAS symptoms are worse and felt for longer with methadone.
Can a Mother Breastfeed on Subutex?
Buprenorphine is passed through the milk to the infant, and the manufacturer of Subutex does not recommend that it be used by nursing mothers.
SAMHSA has looked at the issue and has said that since buprenorphine is not well absorbed in the stomach, babies getting it through breast milk seem minimally affected by it, and that Subutex using women can breastfeed.
Unfortunately, there are no guarantees about the use of buprenorphine while pregnant, and a woman and her doctor will have to make a decision based on individual evidence about what medication is best for any particular situation.
The initial evidence indicates that Subutex offers a safe means for a pregnant women to stay off opiates of abuse, and that babies born to Subutex using mothers suffer fewer and less severe withdrawal symptoms than do babies born to methadone using moms.
On the other side – methadone has been studied and used for a very long time, and it is known to be a very safe medication for use during pregnancy.
Using either Subutex or methadone is preferable to cold turkey style detox or the continuing abuse of opiates.
Because Suboxone contains Naloxone and Naloxone can cause symptoms of withdrawal, pregnant women are advised to switch to Subutex.
- Methadone Pregnancy Information
A great forum community for women on methadone who are pregnant, or who have given birth while on methadone. Lots of support and real-life info here!