Methadone and Suboxone During Pregnancy: Risks and Benefits

Fetal development can be adversely impacted by many drugs, including some over-the-counter medications. Most doctors advise pregnant women to avoid using any substance unnecessarily and will reevaluate the risks and benefits of prescription medications when a woman learns of her pregnancy (Read Pregnancy and Substance Use: A Dangerous Combination). So what happens when a woman is taking methadone or suboxone?

What are methadone and suboxone?

Both of these drugs are used to treat patients with addictions to opiates like Vicodin, Oxycontin, and heroin in addition to a few other medical uses (Read Methadone Treatments: Are They for You?).  Methadone and suboxone (a combination of naloxone and buprenorphine) can prevent withdrawal symptoms and relieve cravings if appropriately administered on a daily basis. Methadone is available as tablets (either to swallow or dissolve in a liquid) or liquid. Suboxone tablets are taken by holding them under the patient’s tongue until they melt; however, if taken via a different method (e.g., injection), the person may begin to experience withdrawal symptoms.  Note that these medicines are not necessarily interchangeable and should not be used to substitute for or supplement each other without a doctor’s instructions to do so.

What are the risks of remaining on these drugs throughout pregnancy?

The federal Food & Drug Administration (FDA) categorizes all medications in terms of their known (or unknown) effects in utero.  Both methadone and suboxone fall into category C; research on the effect of these drugs on fetuses and pregnant women has not been conducted.  Some evidence has indicated that babies born to women on methadone have lower birth weights (and head circumferences); however, these weights are often higher than those of babies born to women taking heroin. Other possible complications include pre-term birth, lower Apgar scores, neonatal abstinence syndrome, chorioamnionitis, and meconium in the amniotic fluid.  Pregnant women who are concerned about their dose or use of these drugs should consult their physician; do not try to discontinue or taper these drugs without being monitored by medical professionals.

What are the benefits of continuing a methadone or suboxone program during pregnancy?

Although category C drugs may pose some risks to the unborn baby, the FDA still encourages their use when the benefits to baby and mother outweigh the risks.  In the case of methadone and suboxone, addiction to stronger opiates and the potential for withdrawal may pose a greater threat to the fetus.  There is also some evidence to suggest that women who use these replacement drugs are less likely to contract HIV (Read Needle-Exchange Programs: A Harm-Reduction Approach) and are more likely to seek out necessary prenatal care. 

What can I do  if I am planning to get pregnant but am addicted to opiates or know someone who is?

It is best to avoid using any type of drug during pregnancy if possible (Read How Addictive Substances Affect Reproductive Health).   If you or someone you know is thinking about having a baby, the health of both mother and baby can depend on stopping an opiate addiction before conceiving.  Contact eDrugRehab to get help with interventions, detox, and rehab placement!