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Is opioid detoxification in pregnancy safe?

This is a complicated question. There is no harm to the fetus to “detox” during pregnancy. In fact, if achieved safely, being off opioids prior to giving birth can be a positive thing because it eliminates the risk that the baby will be born dependent on opioids.

However, we must always balance the benefits of detoxification with the risks to the mother. Moms may need significant medical and social support as they attempt to come off opioids. The good news is, if the mother is not ready to “detox” or be opioid-free during her pregnancy, buprenorphine therapy is a safe and viable option.

Buprenorphine therapy during pregnancy

Historically, providers gave buprenorphine in the form of Subutex to expectant mothers. Subutex is a formulation of Suboxone that contains only buprenorphine. The naloxone component was removed because we didn’t know if it could cause birth defects (teratogenicity).  

As more research has come out about naloxone in pregnancy, most providers now believe that Naloxone has a very low risk of teratogenicity and is safe in pregnancy. Thus, most providers advise keeping a patient on their dose of Suboxone if they become pregnant, versus switching to Subutex. 

As of now, Subutex and Suboxone are both safe options during pregnancy, and it is mostly a matter of patient preference which to use. If you become pregnant while on Suboxone therapy, you may continue your Suboxone and speak to your doctor about the risks and benefits of switching to Subutex or even discontinuing Suboxone. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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