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Pregnancy and Subutex - Treating Opioid Use Disorder While Pregnant

September 24, 2020

We encourage ALL patients to stay on medication-assisted treatment during pregnancy! Treatment for opioid use disorder is a good thing… and that includes during pregnancy. Pregnant patients can safely take either buprenorphine/naloxone (Suboxone) OR buprenorphine-monotherapy (Subutex). Curious as to which is right for you? You’re not alone.  Let’s address some of the most common questions about buprenorphine-monotherapy (Subutex).

What is Subutex?

Subutex is the commonly known brand name for buprenorphine-monotherapy. It is a daily, long-term medication used to treat opioid use disorder that is well-known to be safe and effective. Buprenorphine acts like a partial opioid in the brain, which is different from oxycodone, heroin, and fentanyl. Buprenorphine sits on the opioid receptors, thereby reducing cravings and preventing withdrawal symptoms. Because buprenorphine is a partial opioid, it has a ceiling effect—this means that after a certain dose, there is no additional opioid effect, which ultimately decreases the risk for overdose. Buprenorphine-monotherapy (Subutex) is different from buprenorphine/naloxone (Suboxone), which is a combination of buprenorphine and naloxone.

Subutex Strips

What is the difference between Suboxone and Subutex?

Subutex is buprenorphine only, whereas Suboxone is the combination of buprenorphine with naloxone. Naloxone (commonly known as Narcan) is an opioid antagonist, which means it blocks opioids in the brain. The buprenorphine/naloxone combination is used to discourage misuse of the medication.

How long does Subutex block opiates?

Buprenorphine-monotherapy (Subutex) blocks opioid receptors in the brain for approximately 31-35 hours after sublingual administration (via films under the tongue), which is the most common route for Subutex treatment.

How to take Subutex?

Buprenorphine-monotherapy (Subutex) treatment for opioid use disorder is via sublingual administration, which is placing films (or tablets) beneath the tongue. Patients should not cut, chew, or swallow Subutex. Please consult with a medical provider to optimize your treatment with buprenorphine-monotherapy (Subutex).

What is Subutex used for?

Buprenorphine-monotherapy (Subutex) is primarily prescribed to patients who are pregnant, have severe liver disease, or a documented naloxone allergy. Most other patients are prescribed buprenorphine/naloxone (Suboxone). 

If I’m pregnant do I need to taper off Subutex or decrease my dosage? 

NO! We encourage ALL patients to stay on medication-assisted treatment during pregnancy.

It was initially thought in the early use of buprenorphine/naloxone (Suboxone) that the naloxone component could cross the placenta and have negative consequences on the pregnancy. However, the more experience we have with opioid dependence during pregnancy, we’ve found that the potential naloxone risk is likely overstated. Many providers still err on the side of caution, though, and prescribe buprenorphine-monotherapy (Subutex) during pregnancy. 

Importance of medication-assisted treatment while pregnant

Medication-assisted treatment (MAT) for opioid dependence is the standard of care for pregnant patients, which is endorsed by the American College of Obstetricians & Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM), amongst others. Medically and non-medically supervised opioid withdrawal during pregnancy is not recommended, particularly given the very high rates of relapse. Research shows that with MAT, 75% of patients will still be in recovery one year later. Conversely, studies demonstrate that within one month of stopping buprenorphine treatment, more than 50% of patients relapse to illicit opioid use. And these statistics apply for pregnant patients, too.

Relapse and/or untreated addiction present serious risks for pregnant patients. Research shows that untreated addiction to heroin during pregnancy is associated with lack of (or decreased) prenatal care, increased risk for fetal growth abnormalities, placental abruption (a serious and potentially life-threatening event), fetal death, and preterm labor.  

And further, untreated addiction increases risk for overdose, as well as increases the likelihood of high-risk behaviors like prostitution, trading sex for drugs, and criminal activities. These behaviors put patients at increased risk for sexually transmitted infections (STIs) and violence, as well as legal difficulties, like loss of child custody, criminal proceedings, and incarceration.

Previous research raised concern that opioid withdrawal during pregnancy—from illicit substances, as well as buprenorphine or methadone—may increase risk for fetal death, or miscarriage. However, more recent studies show that medically supervised withdrawal likely does not increase risk for miscarriage, though additional research is warranted. Again, Bicycle Health providers do not recommend medically or non-medically supervised opioid withdrawal during pregnancy, though if patients desire this, we highly advise they first discuss this with their medical providers.

What about Suboxone’s possible effect on neonatal abstinence syndrome?

Neonatal abstinence syndrome (NAS) is drug withdrawal that may result in newborns due to maternal opioid use during pregnancy, including the use of methadone or buprenorphine for treatment of opioid use disorder. NAS is generally characterized by irritability, high-pitched cry, poor sleep, and uncoordinated sucking reflexes that lead to poor feeding. The long-term health outcomes for babies with NAS are not completely understood, and this is an active area of research within medicine. There are a few things we DO know, though:

  • The harms of relapse and/or untreated addiction to the patient and baby far outweigh the harms of NAS. 
  • Recent research shows that buprenorphine treatment often results in less severe NAS compared to methadone. And buprenorphine and methadone treatment result in less severe NAS compared to illicit opioid use.
  • Studies that demonstrate an association between NAS and educational disabilities do not account for many confounding variables, particularly the psychosocial stressors that children experience when growing up in homes with parent(s) who use drugs. That is, children of parents who use drugs are more prone to housing insecurity, food insecurity, violence, inadequate healthcare, and more… and many NAS studies do not account for these social influencers of health

Additionally, the US Food & Drug Administration (FDA) classifies buprenorphine products, like Subutex and Suboxone, as Category C medications, which means the risk of adverse effects during pregnancy cannot be entirely ruled out. However, there is little evidence to suggest any notable risks of buprenorphine treatment during pregnancy.

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Moving forward

The treatment with Suboxone during pregnancy is advised by many health professionals and Bicycle Health recommends all patients stay on medication-assisted treatment during pregnancy! Pregnant patients can safely take buprenorphine-monotherapy (Subutex), buprenorphine/naloxone (Suboxone), or methadone… medication-assisted treatment provides stability, and its benefits far outweigh its potential risks. Though we highly recommend all patients continue MAT throughout pregnancy, if patients desire opioid detox, it’s critical they discuss this first with their medical providers… and here at Bicycle Health, our providers are happy to help you through this decision-making process. 

We’re committed to walking alongside you throughout your recovery. This includes during pregnancy, and any other circumstances that may arise. To learn more about how Bicycle Health’s treatment method can fit into your lifestyle or situation, call us at (844) 943-2514, or schedule an appointment here.

Subutex image by ZngZng under a Creative Commons Attribution 2.0 Generic license.


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