One in five pregnant women fills an opioid prescription annually. These numbers have the potential to evolve into an opioid use disorder (OUD) epidemic if left unchecked.
In addition, opioid use during pregnancy poses significant health risks to the mother and her unborn child. Among these, the threat of delayed fetal growth, still or premature birth, congenital disabilities, and maternal death are particularly concerning. Thus, appropriate and informed treatment for OUD is crucial.
Suboxone is a proven and safe treatment for opioid use disorder, with users reporting up to a 50% decrease in cravings. Below, we break down everything you need to know about Suboxone and pregnancy. But please consult a licensed physician before taking any medication.
What is Suboxone for?
Suboxone is an oral medication FDA-approved for use in OUD. It contains two active ingredients, buprenorphine and naloxone.
Buprenorphine is a partial agonist of opioid receptors. It reduces opioid cravings by binding to and stimulating these receptors in the brain.
Given that it only partially activates opioid receptors, buprenorphine is safer than other opiates. However, users can still misuse buprenorphine by injecting it. This is where naloxone — the other ingredient in Suboxone — comes in.
Naloxone is an opioid antagonist that binds strongly to opioid receptors. It has limited oral bioavailability, meaning it can only enter the bloodstream when injected. In other words, if someone injects Suboxone, naloxone will prevent buprenorphine from binding to opioid receptors. This will precipitate an immediate withdrawal response deterring the user from injecting Suboxone.
Is It Safe to Take Suboxone While Pregnant?
When discussing the safety of Suboxone during pregnancy, it is crucial to look at its two ingredients — buprenorphine and naloxone — individually.
Studies show buprenorphine is safe to take during pregnancy. While there are some risks, which we discuss below, these are minimal compared to other medications (such as methadone). On top of that, its benefits — such as the lower risk of maternal and fetal complications — far outweigh the risks.
Recent data suggests naloxone, too, is safe for pregnant women. A large 2016 cohort study evaluating 640 pregnant women taking medications for OUD found naloxone to have a similar risk profile to other drugs. In addition, naloxone offered some significant benefits, including preventing buprenorphine misuse and decreasing the risk of neonatal abstinence syndrome (NAS).
On top of that, studies show Suboxone carries a lower risk of side effects than other opioids. For instance, according to the Centers for Disease Control and Prevention (CDC), using opioid drugs during pregnancy can cause birth defects, such as glaucoma, hydrocephalus, and congenital heart defects. This risk is lower in pregnant women using Suboxone.
Given the overwhelming evidence, a 2020 update American Society for Addiction Medicine recommends Suboxone for OUD in pregnancy, despite the lack of FDA recommendation.
Neonatal Abstinence Syndrome
Babies born to mothers who use opioids during pregnancy are at an increased risk for neonatal abstinence syndrome (NAS). Recent data shows that up to 6 of 1000 such newborns may suffer from neonatal abstinence syndrome. This risk is much lower in mothers using buprenorphine.
Pregnant women who take drugs such as heroin, oxycodone, codeine, or methadone, can pass them on to their unborn child. Over time the baby becomes dependent on the drug. Thus, when the child is born and no longer receives the drug, it can cause withdrawal.
We can separate NAS symptoms into physical and behavioral:
Fortunately, most cases of NAS are mild and resolve with time. On occasion, severe symptoms may develop with babies needing medicines such as morphine or methadone. These drugs help treat withdrawal symptoms and enable newborns to eat, relax, and sleep.