Is it safe to treat opioid addiction with Suboxone during pregnancy?
If you are a woman who currently takes Suboxone sublingual films or tablets and you become pregnant, should you continue taking Suboxone? Is it safe? First, it is crucial to consider the risks of not taking Suboxone. Why did you start taking it in the first place? If you take Suboxone for opioid addiction, you risk a relapse if you stop treatment. You also may risk opioid withdrawal symptoms, which can be stressful for your pregnancy.
Will they take my baby away?
Methadone vs. Suboxone: Which is better for pregnancy?
First, I should mention that most experts recommend switching from Suboxone to the mono-product version, Subutex, for pregnancy. They are not confident about the safety of taking both ingredients during pregnancy. Suboxone contains both buprenorphine and naloxone. Still, doctors have been giving methadone and buprenorphine throughout pregnancies for many years now. Addiction specialists believe that they are relatively safe, especially compared to the alternative of not getting medical treatment for opioid addiction. While methadone is still the gold standard of treatment for opiate addiction, including in pregnancy, sublingual buprenorphine is proving to be as good and even superior in some ways. If you are pregnant now and planning to start medication-assisted treatment for heroin addiction, which should you choose? The advantage of methadone is that you can start right away, even the same day that you are quitting opioids. The downside is that you must go to a clinic every morning for your daily dose of methadone. Subutex treatment cannot start until you enter a moderate opioid withdrawal state. The waiting period after your last opioid use is typically about 24 hours. However, with some street drugs, such as street fentanyl, you may have to wait longer. If you start Subutex too soon, you will have opioid withdrawal symptoms. You may want to talk to your doctor first to ask about which treatment option is best for you. If Subutex is an option, I recommend going with it over methadone if possible because it is a safer drug, and the patient does not have to go to the clinic every day.
Will my baby be born addicted to opioid drugs?
The concern that many mothers-to-be have is that their baby will be born with neonatal abstinence syndrome (NAS), or more specifically, neonatal opioid withdrawal syndrome (NOWS). The risk of NOWS from buprenorphine is low compared to the alternative. The alternative of a pregnant woman abusing opioids, such as heroin, fentanyl, or oxycodone, carries a much higher risk of harm to the baby and the mother. When it comes to deciding between methadone maintenance or Subutex treatment, studies have shown that NOWS symptoms from buprenorphine are milder than those caused by methadone. While neonatal opioid withdrawal syndrome turns out not to be a problem for many mothers and their babies, the obstetrician must be informed about the mother’s medications. The OB doctor must make plans to deliver the baby in a hospital that can provide appropriate neonatal care. While your baby will most likely have no issues if you are stable on treatment for your opioid addiction, it is best to be safe. You should have your baby in a hospital that can provide the best care possible in any circumstances.
After my baby is born, can I breastfeed while taking Suboxone?
Buprenorphine and naloxone appear in breast milk in minimal amounts. Also, norbuprenorphine, a metabolite of buprenorphine, is found in tiny amounts as well. While there are small amounts of these drugs in breast milk, experts believe it is relatively safe to continue breastfeeding. Again, staying on treatment is essential because the risk of going back to using opioids can be high. Staying in recovery is very important when you are caring for a baby. It is your choice whether you feed your baby formula or breast milk. Discuss your options with your infant’s pediatrician.
Will I have breathing problems during pregnancy from Suboxone?
Suboxone generally does not cause respiratory depression when taken as directed. Other opioids are much more likely to cause breathing problems. It is crucial to stay in recovery, continue medication-assisted treatment with buprenorphine or methadone, and see your doctors for regular monitoring. Keep in mind that breathing problems from Suboxone can be more likely if you also take a benzodiazepine. Again, if you are taking Subutex during pregnancy under the care of a doctor, you are much safer than if you were in relapse. Women abusing street drugs while pregnant can lead to tragic outcomes for mother and baby. Since medication-assisted treatment with Subutex has a higher success rate than abstinence-based rehab by far, it will be best to stay on your medical treatment plan throughout the pregnancy. Of course, the decision about starting or continuing any form of medical treatment is a decision between you and your doctor.
Should I wean off of Suboxone or lower my dose during the pregnancy?
When a doctor prescribes a medication, they will try to find the lowest dosage that provides an adequate effect. Keeping your dosage as low as possible will help minimize side effects. With Suboxone treatment, there are usually at least two significant goals. First, the doctor wants to prevent you from having extended opiate withdrawal symptoms. Second, your doctor does not want you to have cravings for opioids. Sometimes, the dosage that prevents withdrawal symptoms is not enough to adequately suppress opioid cravings. Requiring an adequate daily dosage to manage drug cravings is especially true early in treatment. Your doctor may recommend that you lower your dosage of Suboxone during pregnancy, or they may recommend keeping it the same. It is essential to work with your doctor when it comes to decisions regarding your daily buprenorphine dosage.
Are there risks to the fetus from Suboxone?
Remember that your doctor will likely switch you from Suboxone to Subutex when you become pregnant. The fetal risks of buprenorphine treatment are small. However, you should be aware that there are risks in taking Subutex during pregnancy. Again, you must weigh the risks versus the benefits of treatment. The risk of harm to the fetus from opioid withdrawal symptoms and relapse on dangerous street opioids is much worse than the risks that may be associated with buprenorphine. Sometimes addiction can play mind tricks. While buprenorphine does a pretty good job of suppressing addictive thoughts, they can still creep up on you. If the thought enters your mind about quitting buprenorphine for the safety of the baby, think carefully about your motivations. If stopping treatment might lead you back to relapse and street drug use, you will put yourself at a much higher risk. Pregnancy is a critical time of keeping yourself healthy, so your baby can be born healthy. MAT provides a safety net to protect you and your unborn child from the dangers of active opioid addiction.
Can I get Sublocade shots during pregnancy?
Just like with Suboxone sublingual tablets or films, the monthly Sublocade injection does come with risks during pregnancy. Sublocade is a buprenorphine injection administered subcutaneously, just under the skin. Sublocade lasts all month. Buprenorphine maintenance should, in most cases, be continued in pregnancy to reduce the risk of withdrawal symptoms and the risk of using street drugs, which presents a far greater danger to the mother and fetus. If your doctor is administering Sublocade subcutaneous buprenorphine injections to you each month, he or she may decide to taper your dose or even switch you back to sublingual medication during the pregnancy.
If I have pain after delivering the baby, can I get pain meds if I take Suboxone?
Experts do not recommend narcotic analgesics for patients with a history of addiction to opioids. However, if a patient is having significant pain, the doctor may prescribe an opioid analgesic, such as Percocet, for short term use. Suboxone may reduce the effectiveness of the pain med. If at all possible, you should avoid taking opioids while on Suboxone. Even if your doctor recommends that you use an opioid, such as morphine, Dilaudid, or oxycodone for pain, is it a good idea to take it? If you can tolerate the pain that you may have after delivering the baby, you may want to discuss this topic further with your doctor. While opioids for pain are sometimes needed, they always present the risk of triggering a relapse and a return to active addiction, which can have tragic consequences.
What is the next step to getting help?
If you are already taking buprenorphine for opioid dependence and you are now pregnant, ask your doctor to refer you to an OB/GYN doctor for prenatal care. Or, if you are pregnant and still misusing street opioids or prescription opioids, now is the time to get started right away with treatment. Ask your family doctor for help. If they do not provide MAT, they can refer you to a doctor who can prescribe Subutex. In some cases, methadone will be the best choice. Either way, with medication-assisted treatment, you are well on your way to having a safer, less eventful pregnancy and delivery.