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Do opioids and Suboxone impact neonatal abstinence syndrome (NAS)?

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April 18, 2022

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What is Neonatal Abstinence Syndrome (NAS)?

Neonatal Abstinence Syndrome is a common condition that occurs when a baby becomes used to opioids during pregnancy and inside mom’s body. A few days (2-4 days) after being born and outside of mom’s body, the baby will experience withdrawal symptoms, similar to symptoms adults feel when withdrawing from opioids--irritability, difficulty feeding, reflux or vomiting, diarrhea, sneezing, stuffy nose, or yawning. This is common, occurring in 30-80% of babies exposed to opioids during pregnancy.

This can occur when the mom takes any type of opioid on a regular basis, including illicit drugs, prescription medications, and/or medications to treat opioid addiction. A list of these opioids is below.

Prescription & Illicit Opiates

Evidence-based medications that treat opioid addiction (MAT)


How is NAS treated?

The staff in the nursery will monitor your baby very closely. Your baby will need to stay in the hospital for at least 5-7 days after birth for monitoring. Different nurseries use different monitoring tools. Examples include the Finnegan NAS tool and the Eat Sleep Console (ESC) tool.

NAS Treatment

When your baby shows signs of withdrawing, there a lot of things that mom can do to support her baby. These include supportive care, like:

  • Breastfeeding (as long as no contraindications like HIV)
  • Skin-to-skin contact
  • Creating a low stimulation environment that is dark and quite
  • Swaddling
  • Providing frequent feedings to reduce stress

Sometimes medications will be used when infants have more severe symptoms, such as morphine or methadone. These will help your infant feel more comfortable and will be slowly tapered off.

**NAS symptoms may be more severe if mom also takes/uses: nicotine, SSRIs (a treatment for depression), and benzodiazepines (medications like Klonopin, Xanax, Valium, and Ativan).

Since buprenorphine/naloxone (Suboxone) and methadone can cause NAS, should I take these during pregnancy?

Yes! Medications for addiction treatment (MAT), including buprenorphine/naloxone (Suboxone) and methadone, are considered first-line treatment and standard of care for pregnant patients with opioid addiction.

For any choice, patients should weigh the risks and benefits. There is a potential and very small risk of birth defects associated with MAT. However, the risk of not being on MAT and continuing to use or relapse on illicit opioids can cause destabilization for mom and lead to terrible outcomes, including overdose/death for mom, spontaneous abortion, and intrauterine growth retardation (IUGR) for baby.

For these reasons, treatment with buprenorphine/naloxone (Suboxone) and methadone is recommended for optimal health for both mom and baby by the American College of Obstetricians and Gynecologists (ACOG), a physician group that promotes evidence-based medicine.

Recommendations for patients with addiction to opioids thus include:

  • For patients already on buprenorphine/naloxone (Suboxone) or methadone: it is recommended to continue this MAT treatment during pregnancy
  • For patients NOT already on buprenorphine/naloxone (Suboxone) or methadone: it is recommended to start MAT during pregnancy

Bottom line: 

  • Your baby is much safer being exposed to buprenorphine/naloxone (Suboxone) or methadone than to heroin or fentanyl and other non-prescribed opioids
  • MAT IS recommended for optimal maternal and fetal health!

If I have an addiction to opiates, what treatment option is right for me? Should I take buprenorphine/naloxone (Suboxone) or methadone during pregnancy?

This is certainly an individual choice and should be up to mom.

Both medications are considered evidence-based, first-line and standard of care for treating addiction and dependence to opioids during pregnancy.

Recent evidence suggests that taking buprenorphine/naloxone (Suboxone) during pregnancy can lead to shorter hospital stays and less use of medications to treat babies for neonatal abstinence syndrome (NAS).

While buprenorphine/naloxone (Suboxone) is usually prescribed in an outpatient setting and with weekly to monthly prescriptions, moms attending a methadone program may benefit from the added structure and routine of daily attendance. 

Regardless of which medication is chosen, pregnancy can be a particularly stressful time in a woman’s life, and it will be very important for mom to take care of her physical and mental health. Mom should seek out a comprehensive program that supports her mood symptoms (such as anxiety and depression) with therapy and medications and provides access to other resources and programs, like parenting and birthing classes, to help build a sense of confidence and best prepare her.

I have heard that if I am on buprenorphine/naloxone (Suboxone) or methadone during pregnancy that I will be reported to my local child welfare organization. Is that true?

Yes, despite the benefits of being on MAT during pregnancy, since the infant is considered “substance exposed,” health care providers are mandated to report being on this medication to child welfare organizations. This means that the organization will be involved to ensure that mom remains in recovery and creates a safe, loving environment for her baby. 

Other important tips: 

If you are pregnant or preparing to become pregnant, talk to your Health Care Provider:

  • Tell your provider about any drugs or medicine you take, including opioids.
  • Do not stop taking opioids without talking to your provider first. 
  • If you are taking opioids, ask your provider about medications for addiction treatment (MAT), including buprenorphine/naloxone (Suboxone) and methadone.
  • If you do not desire to become pregnant, ask your doctor about birth control

Summary and Take Home Messages:

  • Neonatal abstinence syndrome is expected, common, and treatable and includes symptoms of opioid withdrawal that occur when babies are born to moms on opioids (including medications used to treat opioid addiction, like buprenorphine/naloxone/Suboxone and methadone)
  • Babies with NAS symptoms are monitored and treated in nursery with both supportive care and sometimes medications.
  • It is recommended that moms with opioid addiction get on or stay on MAT including buprenorphine/naloxone (Suboxone) or methadone for OPTIMAL outcomes for both mom and baby.
  • Moms should seek comprehensive support before, during, and after pregnancy that allows them to address their physical and mental health care needs.

If you or someone you know are pregnant and interested in learning more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment in comparison to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.

Header Photo by Eric Froehling on Unsplash

Randi Sokol, MD, MPH, MMedEd

Randi Sokol, MD, MPH, MMedEd, is an Assistant Professor at the Tufts Family Medicine Residency Program and Instructor at Harvard Medical School. She is Board Certified in both Family Medicine and Addiction Medicine. She earned her B.A. at the University of Pennsylvania, her Medical Degree and Masters in Public Health from Tulane University, completed Family Medicine Residency at UC-Davis, and earned a Masters in Medical Education through the University of Dundee.

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