Methadone or Suboxone during Pregnancy?

Why take methadone (or Suboxone) during a pregnancy? - As a mom to be, you want to do what’s best for your baby, and getting on something like methadone, which causes a withdrawal syndrome in newborns, may not feel like the right thing to do.

While it’s obviously preferable for a pregnant women to abstain from all opiates, those who become pregnant while addicted to opiate drugs should not try to quit ‘cold turkey’ and should rather use an opiate substitution medication, like methadone, to manage drug withdrawal symptoms and to maintain better health.

Although your natural impulse after learning of a pregnancy may be to abstain from future drug use to safeguard the fetus, the sudden cessation of opiate drugs is very difficult on the unborn child (as it is on the mother) and is likely to result in miscarriage. Additionally, opiate abusing women who attempt to quit without appropriate addiction treatment and assistance are at high risk of relapse back to opiate abuse – which greatly increases the chances of pregnancy complications.

Although taking methadone while pregnant may seem a bit strange, methadone is the gold-standard treatment for pregnant women – the treatment that is most likely to promote good health in mother and child.

The Risks of Opiate Abuse during Pregnancy

Opiate abuse may have affected your health and if you abuse opiates during your pregnancy, you are putting the health of the unborn child at risk as well. Getting treatment for your addiction while pregnant lets you regain personal health and wellness prior to delivery as it also reduces the odds of medical complications that can be directly caused by the abuse of opiates.

Opiate abusing women are statistically more likely to suffer from disorders that can affect the unborn child or be transferred during childbirth, such as STDs, HIV/AIDS, Hepatitis B and C and others.

The abuse of opiates during pregnancy can cause medical complications that may include:

• Reduced fetal growth
• Intrauterine death
• Insufficient placenta
• Hemorrhage after birth
• Preeclampsia
• Premature delivery
• Miscarriage
• Others

Abusing opiates during pregnancy put mother and child at greatly increased risk of poor outcomes.

Methadone during Pregnancy

Methadone has been intensely studied for more than 50 years, and it is a confirmed safe drug for mother and child during pregnancy. As a long acting opiate, mothers taking methadone maintain a very stable level of the opiate drug in the blood, which spares the fetus the stress of intoxication and withdrawal cycling each day.

Additionally, women taking methadone have frequent contact with medical staff, and ideally (often) this results in improved prenatal care for mother and child. This improved prenatal care is associated with a further reduction in medical complications.

Methadone is considered the gold standard of care for opiate abusing pregnant women and it is FDA approved for the treatment of this population.

In the past, mothers on methadone have attempted to reduce their methadone dosage over the course of a pregnancy to spare the unborn child methadone withdrawal symptoms after birth. Research has not shown that reducing the dosage of methadone reduces the likelihood of neonatal abstinence syndrome (NAS) but studies have shown that women who attempt to taper down their dosage while expecting have

• Decreased weight gain
• More illicit drug abuse
• Less compliance with prenatal care guidelines
• Lower birth weights
• Smaller infant head circumferences
• Slower fetal growth
• Premature delivery

Methadone and Neonatal Abstinence Syndrome (NAS)

One of the biggest concerns most women have while pregnant and on methadone is the probability that their infant child will suffer through an opiate withdrawal syndrome in the first days of life.

Between 60% and 80% of infants born to mothers using methadone will experience NAS symptoms. Symptoms generally begin within the first 2 to 3 days, but can be delayed by as much as 4 weeks. Symptoms generally endure for between 10 and 21 days, but can last as long as 42 days.

Symptoms of NAS include:

• Irritability and a characteristic shrill crying
• Oversensitivity to external stimulation
• Tremors
• Frantic sucking on digits, which can interfere with the ability to feed normally
• Vomiting and diarrhea
• Rapid respiration
• Fever
• Yawing
• Others

Infants with NAS can be treated with medications, such as tincture of opium, which reduce the severity of withdrawal symptoms. Keeping these infants in rooms with low stimulation and swaddled can also reduce distress.¹

Women on methadone can breastfeed normally.

Buprenorphine during Pregnancy

While methadone is the accepted standard of care drug for pregnant opiate addicted women, doctors may, in some cases, decide that buprenorphine is a better choice.

Due a lack of controlled study data demonstrating the safety of buprenorphine for use by pregnant women, the FDA has not yet approved buprenorphine for use by pregnant women unless the benefits of its use outweigh the potential harms of non use. When doctors choose to prescribe buprenorphine to pregnant women, they will customarily prescribe Subutex (buprenorphine only) rather than Suboxone (buprenorphine and naloxone), to reduce the risks of precipitated withdrawal on the fetus.

Initial case studies of buprenorphine (the active ingredient in Suboxone and Subutex) on pregnant women indicate that it is a well tolerated and effective medication for use by pregnant women.

Doctors may choose to use buprenorphine during a pregnancy in some situations, such as:

• When methadone services are locally unavailable
• The patient cannot tolerate methadone or refuses to use it
• The patient has been informed of the risks of buprenorphine use during pregnancy (a lack of studies)

Using buprenorphine during pregnancy can result in neonatal abstinence syndrome (NAS)

In clinical studies, about half of babies born to women using buprenorphine suffered from NAS that was severe enough to merit treatment. Women in these studies may have been using other drugs that exacerbated the NAS, and so buprenorphine only may result in NAS less frequently.

Buprenorphine NAS symptoms most typically peaked within 3 or 4 days and dissipated within a week.²

The Importance of Integrated Addiction Treatment and Prenatal Care

Opiate addicted pregnant women generally benefit from more than basic addiction treatment. Women emerging from a period of opiate addiction may need assistance in developing good health, stability in financial, relationship and housing situations and readiness to be a good parent. For best outcomes for mother and child, opiate addiction treatment should include elements such as³:

• Prenatal care
• Family therapy and relationship counseling
• Parenting classes
• Assessment and support for those enduring domestic violence, financial problems and housing issues
• Testing for infectious diseases

Getting Help

Although taking an opiate medication while pregnant seems wrong, decades of research have proven that methadone (or buprenorphine, in some situations) is the best treatment available for both mother and child during pregnancy.

If you are pregnant and abusing opiates, getting into a methadone treatment program, getting your life back on track and really getting prepared to be a good mother is the best way to start taking care of you and your child.