baby methadone

Methadone and Suboxone Best Treatment Options for Pregnant Women

by Tom on February 7, 2012 · 23 comments

Pregnant women who are addicted to heroin or prescription pain relievers should be treated with either methadone or buprenorphine (Suboxone, Subutex).

This according to new guidelines recently published by the American Academy of Pediatrics.

I wasn’t surprised by the new guidelines, because similar recommendations have already been made by the U.S. National Institutes of Health and the World Health Organization, among others.  And it is well known that detoxification from opiates during pregnancy is associated with increased risk of fetal harm and may result in loss of the pregnancy.

Medication-assisted treatment with methadone or Suboxone is a responsible choice for pregnant women who are opiate dependent.  Women who make this choice should be praised and supported.

Instead, the opposite often happens.  And pregnant women who follow the scientific evidence and top expert medical advice often face stigma.

Part of this stigma stems from inaccurate claims that babies will be born “addicted.”  The truth is that babies born to women in treatment with methadone or Suboxone are not addicted.

Addiction refers to dysfunctional and compulsive drug use that continues in spite of negative consequences.  Clearly, a newborn baby is not capable of using compulsively, or having a dysfunctional relationship with a substance.  And we should remember that without the methadone or Suboxone, it’s quite possible that there would be no newborn at all.

Labeling an infant born to a mother in treatment with methadone or Suboxone “addicted” is not only inaccurate, it also contributes to stigma.  Such stigma can lead to punitive treatment of the mother and negative consequences for both the mother and child.

Many babies born to mothers in treatment with methadone or Suboxone will experience some symptoms of physical withdrawal after birth, but this results from physical dependence on the medication and not addiction to the medication.

Withdrawal symptoms may be uncomfortable for the baby.  But they are a side effect of a medically necessary medical treatment.  They are temporary, can be treated to limit distress to the baby, and are not known to cause any long term harm.

Mothers who are in treatment with methadone or Suboxone are encouraged to breast feed their babies (unless otherwise contraindicated).  Small amounts of methadone or Suboxone that may be passed to the baby with the breast milk can help reduce any symptoms of withdrawal.

Research shows that women who are pregnant and addicted to opiates have the best outcomes for themselves and their child when they:

  • Participate in treatment with methadone or Suboxone while they are pregnant
  • Breastfeed their baby
  • Continue methadone or Suboxone treatment as needed to successfully initiate and maintain long term recovery

Medication-assisted treatment is responsible for the safe delivery of many healthy babies to mothers who would otherwise still be using, and therefore less able to parent successfully.

Perhaps the Academy of Pediatrics should recommend medication-assisted recovery for expecting fathers who are addicted too.  I know I do.

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{ 22 comments… read them below or add one }

1 Heidi June 15, 2012 at 3:41 pm

i am 14 weeks pregnant and i went two days ago to my regular appointment at the suboxene clinic and i was discharged because they said my levels were not right, they gave me a number to another clinic to use. i have not been able to get in another clinic until 2 weeks from now, i tired to call my recent doctor for a script until i can get into another doctor and he wouldnt even talk to me. i had supervised drug test every time i came in there and never failed a drug test. i was at every doctor visit on time. i know other pregnant women that go to the same doctor and they told me when i told them of my situation that they have not passed one drug test since being there and they are still going to that doctor. i dont understand, i feel like i was being picked on because maybe they didnt like me

2 recoveryhelpdesk June 19, 2012 at 11:18 pm

I’m sorry to hear about that Heidi. You have the right to file a complaint about your doctor to your state medical board. You can find out how by searching online. Also, you will probably be offered written information about this when you start with your new doctor.

If you feel like the doctor is in the wrong, filing a complaint is probably the right thing to do. Your doctor has had no problem holding you “accountable.” And your doctor should be accountable too. By filing a complaint, you will force the doctor to reflect on and defend his/her actions. And your doctor may find benefit from the process by learning better ways to treat patients in the future.

From what you describe, I do think the situation could have been handled better by your doctor. First, drug test results are tricky things especially when it comes to “levels.” I suspect the testing lab would say that the test is not capable of providing accurate “levels” to a standard that would justify discharge based on the test results. This is especially true given the fact that other indications suggest that you are stable in your recovery. And given the fact that you are pregnant.

In any event, it doesn’t sound like your doctor is consistent in how patients are treated.

My own feeling is that the doctor put your recovery and safety at risk by allowing a gap in treatment when addressing the issue in a way short of discharge, or bridging you to another provider would have been a reasonable option.

Best of luck to you in both your recovery and pregnancy!

3 Jessica October 20, 2012 at 12:33 am

I just had a baby girl 8 days ago while on suboxone, 4mgs a day. Now cps is involved and taking me to court. I fear I am going to lose custody. I am not allowed to take her home and I know I have to go to rehab among other things to establish my rights again. They are acting as if I am a criminal. My daughter is going through NAS and is still in the neonatal. They put her on methadone, of course without my imput. Her symptoms are minor. I thought I was doing the right thing and am being tortured by this. I have been clean with suboxone for four years. I am broken hearted and lost without her.

4 recoveryhelpdesk October 20, 2012 at 9:33 pm

Hi Jessica. That is horrible. Please email me at tom@recoveryhelpdesk.com so I can learn more about your situation and see if there is something I can do to help.

Tom

5 Jessica October 23, 2012 at 2:38 pm

A few hours ago a foster parent took my daughter from the hospital. Cps is telling me there is court but no papers have been filed yet so I am at a standstill. The father and I are together and they are demanding a paternity test because we are not married. He signed the affidavit of paternity and has no doubt but they will not give him custody without the test. Everything is waiting on court to see what the judge says. I never thought I would have to go to rehab for rehab. I got clean years ago witht he help of suboxone. I was addicted to opiates. I got a job and worked my way up over the four years to running numerous restraunts, bought a car, got an apartment… basically got my life back on track. I am not a bad person. I wanted to get off suboxone after my daughter was born, I knew doing it while pregnant wasn’t safe for her. I pray this nightmare is over soon. I love her and miss her so much. I will NEVER stop fighting.
I tried to email you Tom but the link isn’t working. Any advice anyone???
thank you for your time.

6 Jessica October 23, 2012 at 2:41 pm

There is a nurse that works at the hospital that my daughter was born in who also works at a suboxone clinic and stated that this is nothing more than uneducated docters and social workers. That I did the right thing, the safest thing I could for my daughter.

7 recoveryhelpdesk October 23, 2012 at 8:09 pm

Hi Jessica, I agree with the nurse that said you are the victim of ignorant doctors and social workers. I’m not sure why the link to my email wouldn’t work. Can you try typing in the address tom@recoveryhelpdesk.com instead of trying to click on the link? Maybe this will work. I would like to know what state you are in, and how I can get in touch with you by email or telephone to ask you some more questions and see if I can help. I am so sorry that you are going through this nightmare. Thanks, Tom

8 Ashley November 5, 2012 at 8:11 pm

I just want to make a comment about being pregnant and being on Suboxone. I initially got on suboxone last year in October, and I was 6 months pregnant at the time with my daughter. I feel as if Suboxone saved my life and is a miracle drug! I don’t know what I would do without it! I had my daughter 4 weeks early, Feb. 24th, 2012 and she was only in the hospital for 3 days and on the 4th day was able to take her home! She had barely any withdrawal symptoms, and never had CPS involved or anything. I’m in Ohio, and I know each state is different, but according to the caseworkers here, as long as you have a legal prescription from your doctor, they are not allowed to take your baby! That’s crazy and aweful! I feel sooo sorry and bad for Jessica! I don’t know what I would do if I was in the situation! But now i’m expecting another little girl in February again (lol), and am still on suboxone and feel great! I am hoping and praying that this one will be as lucky and blessed as my last one when it comes to coming home only 4 days of being in the hospital. :)

9 recoveryhelpdesk November 6, 2012 at 12:15 pm

Hi Ashley, Thanks for taking the time to share your experience. Congratulations on your recovery success and on your growing family! Tom

10 ali November 12, 2012 at 8:52 pm

I had my daughter 2 weeks ago…I have been on 16 mgs a day…my doctor never said anything about her going through withdrawals all he said was she might be “fussy”…she has been in the nicu for 12 days now on morphine and every time they try to lower her dose her scores go up. They started her on .12 which is the lowest starting dose and have tried bringing her down 3 times already with no luck. CPS never got involved and I hope they don’t since I did exactly as I was told by both my ob and suboxone doctor. I was just wondering if anyone has gone through something like this and can say how long it takes for them to get off the morphine :( I’m still really upset I was better informed so I could have been more prepared mentally!

11 ali November 12, 2012 at 9:00 pm

Ashley-the neonatal doctor told me that since I was on suboxone at the time of conception until she was born that every cell in her body is use to it and with drawl can be more difficult…I’m not sure what dose your on and everyone is different so it could very well be the same situation as your first…they also said if I lowered my dose I could have miscarried or had her still born, possibly even with fetal defects! Once again this was all told to me AFTER her birth since they don’t want pregnant mothers worrying…I hope it all goes well! I’m only mentioning this because I feel our doctors should disclose all possible outcomes with us prior to delivery!!!

12 sadie November 17, 2012 at 4:24 am

I have been on suboxone for over two years and i recently became pregnant Im 14 Weeks now and when i found out i was pregnant i was 6 Weeks, i immediately lowered down to 2mg a day but i want to completely quit soon.i don’t wasn’t to take it throughout my pregnancy but I’m scared that the withdrawals will hurt my baby. I’ve read that no matter how much you ween yourself down the withdrawals are still just as bad. I am not prescribed them i get them from my sister because we were both addicted to roxycodone and she went to rehab instead of me because she had insurance and i didn’t so we gave just been sharing get script for 2 years,

13 sadie November 17, 2012 at 4:32 am

…sooo because she is the one with the doctor i can’t ask to be put on subutex, which i heard was safer, and i can’t get advise on how to safely quit, I’m stuck, I don’t know what i should, should i just stop taking it and deal with the withdrawals since I’m now in my second trimester or shouldi continue taking it throughout my pregnancy

14 natalie1979 December 23, 2012 at 8:26 pm

I just found out im 5 weeks pregnant i am addicted to methadone but dont get it legally anymore.im scared the pregnancy was an accident and i am married but is there even a doctor who would help me and put me on suboxone without involving cps..im in indiana btw thanks guys and plz dnt judge me i feel terrible.

15 natalie1979 December 23, 2012 at 11:26 pm

Anyone..please?

16 Alison December 28, 2012 at 12:40 am

I have been having a problem with percocet for a year and I finally have an appointment with a methadone clinic tomorrow, its not that I didn’t ask for help its that I couldn’t get any! I wish I could have gotten help before I got pregnant but was turned away, the only free clinic was an inpatient clinic demanding I states one week with no contact with my kids & no cell phone or outside calls! So I asked for information when I had a phone interview about what medication was best for me during detox & they told me it was up to me! For me the fear of CPS, the NICU & not being able to bond or breastdeed

17 Christina January 4, 2013 at 3:14 am

Hi my name is Christina. I have started a suboxone program about 2 months ago. I was addicted to pain killers (have not used any at all since) and for the first time in a very long time I finally feel normal again. I feel like my head is clear. While I was using I always put the thought of having another baby out of my head because of my addiction. My husband always brought it up to have another and I always scheduled appointments to have my tubes tied and never followed through for some reason. Now that I’m back to my old self (the way I should feel). Thoughts of pregnancy have entered my mind. I have researched, spoke with the Drs.,and there is pregnant women at my Suboxone clinic. They have all said it would be safe while on the suboxone. Then I come across Jessica and I feel so sorry for her. I hope everything worked out for her. I would love to know how she is. I live in Virginia and I worry that the same thing would happen. I already have been blessed with two beautiful, smart, and just all around wonderful children. They are my life and have never been one night away from me unless it was my say so. Jessica’s story saddens my heart and puts a fear in me that makes me want to reconsider. Can they really do that to someone that is trying to keep their baby healthy and better their self? I wish there were more education on this. I think it should be a requirement that everyone in the medical field is trained in addiction.

18 Tosha January 17, 2013 at 10:06 pm

I jus had my daughter 2 weeks ago and i was on subutex my whole pregnancy i had a beautiful healthy little girl, but she is currently in the nicu for withdrawals, an they have her on,morphine, i was not aware this could happen either, im breastfeeding her N have sum concerns bc i jus got switched bak to suboxone instead of subutex, i dont feel its safe anymore to breastfeed with her being on,morphine bc obviously i couldnt take morphine while on suboxone so how is it ok 4 her to get it threw my breastmilj all the drs say its fine i jus want more opinions on it please

19 recoveryhelpdesk January 18, 2013 at 9:05 pm

Hi Tosha,

I’m not a doctor so I can’t give medical advice. I can say that I think you should listen to your doctor who has years of medical training and experience.

I also think that it makes sense that it is okay to breastfeed while on Suboxone. Suboxone is a combination of buprenorphine and naloxone. The naloxone is put in there because it supposed to make it so that Suboxone can’t be injected. If you take Suboxone under your tongue, the naloxone isn’t released. But if you inject it, the naloxone is released and knocks off any opioid (such as morphine) molecules off the receptor sites in your brain so you go into withdrawal and feel sick (doesn’t always happen because it depends on the timing of what you use when). As long as the Suboxone isn’t being injected into your baby (obviously not) then it makes sense that there would not be a problem. Confirm this with your doctor, and also ask your doctor about the benefits to your baby that come with breast feeding (there are many).

Congratulations and best wishes to you and your baby girl. I wish you both health and happiness. Tom

20 Shawntell June 12, 2013 at 7:39 pm

I’m 7 weeks pregnant and was just told by a doctor that I need to go to the emergency room to be put on Subutex instead of Suboxone. My OB knows I’m on Suboxone and the doctor I saw today is not my prescribing doctor. I had a miscarriage 7 weeks ago and fear that the medication is the reason. I have been cutting down gradually but do feel the withdrawal symptoms and also fear that will harm my baby. Since I see the high risk doctors (due to suboxone) at a major university medical center it takes weeks to be seen. Should I just quit taking it all together or request Subutex? Does Naloxone pass the placenta? I’m taking less than .5 mg film a day down from 6 mg before I got pregnant.

21 recoveryhelpdesk June 13, 2013 at 5:48 pm

Hi Shawntell,

I would suggest that you call your OB doctor’s office, explain the situation, and ask for your OB doctor’s advice. You should be able to get information that way without waiting weeks to be seen.

Pregnant women are often prescribed Subutex instead of Suboxone (to avoid the naloxone), but this is not always the case. Ask your OB doctor why Suboxone is better for you than Subutex in your situation.

I would not suggest that you change your medication or dose without first asking your OB doctor. A stable dose of buprenorphine (Suboxone or Subutex) is likely to reduce your risk of miscarriage. You should not change your dose without doctor supervision.

Best of luck to you!

Tom

22 Amy August 8, 2013 at 11:12 pm

Does anyone know the laws in NJ as far as DYFS getting involved with babies born on subutex? I’ve just recently during my 7th month started receiving my subs through a doctor and want to know what I’ll be dealing with in the hospital…should I try to look into contacting an attorney to be sure??

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