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 important 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 relapse if you stop treatment. You also may risk opioid withdrawal symptoms which can be stressful for your pregnancy.
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 certain of the safety of taking both ingredients in Suboxone, buprenorphine and naloxone, during pregnancy. That being said, methadone and buprenorphine have been used throughout pregnancies for many years now and both are considered to be safe, especially compared to the alternative of not getting medical treatment for opioid addiction. While methadone is still considered to be 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.
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 far less compared to the alternative of a pregnant woman abusing opioids, such as heroin, fentanyl, or oxycodone. Studies have shown that NOWS symptoms from buprenorphine are more mild than those caused by methadone. While neonatal opioid withdrawal syndrome turns out not to be a problem for many mothers and their babies, it is important that the obstetrician is informed about the mother’s medications and plans to deliver the baby in a hospital that can provide appropriate neonatal care.
After my baby is born, can I breastfeed while taking Suboxone?
Buprenorphine and naloxone are found in breast milk in very small 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, it is considered to be safe to continue breastfeeding. Again, staying on treatment is important 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 it is taken as directed. Other opioids are much more likely to cause breathing problems. It is important 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.
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. This will help minimize side effects. With Suboxone treatment, there are usually at least two major 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. Your doctor may recommend that you lower your dosage of Suboxone during pregnancy, or they may recommend keeping it the same. It is important to work with your doctor when it comes to decisions regarding your daily Suboxone use.
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.
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 that is given subcutaneously, or just under the skin. Sublocade lasts all month and is given on a monthly basis. Buprenorphine maintenance should, in most cases, be continued in pregnancy to reduce the risk of withdrawal symptoms and going back to using street drugs, which presents 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?
Narcotic analgesics are not recommended for patients who have been addicted 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 take 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.