Pregnant

Buprenorphine has an excellent safety profile but there are some important contraindications. Buprenorphine is not indicated for:

  • Patients under age 16
  • Pregnant women
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Description: 
Four-page document discussing treatment of pregnant patients with buprenorphine.
Source: 
Physician Clinical Support System (PCSS)
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Newborn

The safety of buprenorphine use during breastfeeding is promising, but not yet clearly established (Kraus et al. 2011).

View ReferencesHide References
Food and Drug Administration (FDA). Medications Guide. btodrems.com. 2013. Available at: https://www.btodrems.com/SitePages/MedicationGuides.aspx Accessed on: 2013-10-09.
Jones HE. Treating opioid use disorders during pregnancy: historical, current, and future directions. Subst Abus. 2013; 34(2): 89-91. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23577898 Accessed on: 2014-02-05.
Kraus ML, Alford DP, Kotz MM, et al. Statement of the American Society of Addiction Medicine Consensus Panel on the Use of Buprenorphine in Office-Based Treatment of Opioid Addiction.. Journal of Addiction Medicine . 2011; 5(4): 254-263. Available at: https://www.asam.org/docs/advocacy/use-of-buprenorphine-in-office-based-treatment-of-opioid-addiction.pdf Accessed on: 2013-12-12.
O’Connor AB, Collett A, Alto WA, O’Brien LM. Breastfeeding rates and the relationship between breastfeeding and neonatal abstinence syndrome in women maintained on buprenorphine during pregnancy . Journal of Midwifery Women’s Health. 2013; 58(4): 383-8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23931660 Accessed on: 2014-06-18.
Substance Abuse and Mental Health Services Administration (SAMHSA). Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction. Rockville, Md: Center For Substance Abuse Treatment. Treatment Improvement Protocol Series, No. 40, USDHHS Publication (SMA) 04-3939. 2004b. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64245/ Accessed on: 2013-10-08.
Related Resources: 
Description: 
Four-page document discussing treatment of pregnant patients with buprenorphine.
Source: 
Physician Clinical Support System (PCSS)
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Physician stage in practice: 

Buprenorphine and Pregnancy -- What You Need to Know

Description: 
This patient handout sheet explains concerns and risks for buprenorphine treatment of patients who are or wish to become pregnant.

Buprenorphine and Pregnancy -- What You Need to Know

Abusing heroin or prescription painkillers while you are pregnant is very dangerous --both for your own health and for the health of the baby you are carrying. The best action you can take is to get into treatment and stop using drugs.

What happens if you are pregnant (or want to become pregnant) and want to start taking buprenorphine?

Methadone maintenance treatment and buprenorphine monotherapy are both appropriate choices for pregnant women with opioid use disorder.

Drug-free treatments, naltrexone treatment, or "detox" are also good choices if you are just planning a pregnancy, but they are a bad idea if you are already pregnant --these treatments will force you to go into withdrawal, which could cause a miscarriage.

Your provider can advise you about other treatments and help you choose one that it right for you.

What happens if you are already using buprenorphine and want to get pregnant?

If you want to get pregnant, the safest thing to do is switch to another treatment that is safe to use during pregnancy -- methadone, naltrexone, or a drug-free treatment.

Let your provider know in advance if you want to become pregnant so you can work together to plan your change in treatment. Also, use birth control to reduce the chance of having an unplanned pregnancy.

But what happens if you are taking buprenorphine and get pregnant unexpectedly?

In this situation, you have 2 things to consider:
 There is a small chance that buprenorphine will hurt your child, but

If you switch from buprenorphine to any other kind of treatment (except for the buprenorphine only form --see below), you will probably go into withdrawal --and withdrawal could cause a miscarriage.

Miscarriage from withdrawal is the greater of these 2 risks. So, if you are already on buprenorphine and you become pregnant, you should not switch to another treatment.

There is only one change you should make --your provider will probably switch you from buprenorphine/naloxone combination to buprenorphine only form (monotherapy). Monotherapy has the same active ingredient as the buprenorphine/naloxone combination formulation and is used in the same way, but it doesn't have another ingredient (naloxone) which could be dangerous to take during pregnancy.

Remember to talk to your provider if you wish to become pregnant or suspect you are pregnant at any time while taking buprenorphine.

Description: 
This chapter provides information on using buprenorphine in patients who have special circumstances, including patients who have comorbid medical conditions or pain, pregnant patients, and adolescents.
Source: 
Substance Abuse and Mental Health Services Administration (SAMHSA)
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Physician stage in practice: 
Description: 
This 2005 randomized controlled study examined transitioning women from short-acting opioids to buprenorphine with respect to safety and withdrawal discomfort.
Source: 
Drug and Alcohol Dependence
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Physician stage in practice: 
Resource Type: 
Description: 
This consent form -- reproduced with permission from the Boston Medical Center -- can be used with your pregnant patients who want to continue taking buprenorphine during pregnancy.
Source: 
Boston Medical Center
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Commonly Used Forms: 
Description: 
A 585 page report by the National Center on Addiction and Substance Abuse document the evidence defining and describing the disease of addiction/risky substance use. It describes the need for and effectiveness of wide screening and interventions treatment and disease management tools and therapies as well as the populations in greatest need of therapies. The barriers to treatment, training and education gaps, and consequences and costs of inadequate prevention and treatment are all described. Finally, profound gaps between those who need treatment and those who receive quality care are described.
Source: 
National Center on Addiction and Substance Abuse
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Description: 
Presently, methadone is the recommended treatment for opioid-dependent pregnant women, but is associated with neonatal abstinence syndrome (NAS). NAS is characterized by opioid withdrawal symptoms in the newborn, which often requires longer hospitalization and treatment. Buprenorphine, FDA-approved in 2002 for the treatment of opioid dependence in non-pregnant individuals, hasn't been extensively studied during pregnancy. Yet, a new study in the New England Journal of Medicine (NEJM) found that buprenorphine offers an alternative to methadone in the treatment of opioid-dependent pregnant women. The study compared buprenorphine to methadone in 131 mothers and their newborns at eight international sites.
Source: 
New England Journal of Medicine
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Buprenorphine y el embarazo – que usted necesita saber (en Español)

Description: 
This patient handout sheet explains concerns and risks for buprenorphine treatment of patients who are or wish to become pregnant.

Suboxone y el embarazo – que usted necesita saber

Abusar la heroína o los analgésicos recetados mientras usted está embarazada es muy peligroso –
ambos para su propia salud y para la salud del bebé. La mejor acción que usted puede tomar es entrar
en un programa de tratamiento y dejar de consumir drogas.

field_vote: 
Patient Handouts: 

Buprenorphine and Pregnancy -- What You Need to Know

Description: 
This patient handout sheet explains concerns and risks for buprenorphine treatment of patients who are or wish to become pregnant.

Buprenorphine and Pregnancy -- What You Need to Know

Abusing heroin or prescription painkillers while you are pregnant is very dangerous --both for your own health and for the health of the baby you are carrying. The best action you can take is to get into treatment and stop using drugs.

What happens if you are pregnant (or want to become pregnant) and want to start taking buprenorphine?

Methadone maintenance treatment and buprenorphine monotherapy are both appropriate choices for pregnant women with opioid use disorder.

field_vote: 
Patient Handouts: 

Flow Chart

Description: 
Switch from Buprenorphine to Buprenorphine/Naloxone

This flow chart depicts clinical guidelines for switching a patient from buprenorphine to buprenorphine/naloxone. Guidelines are provided for whether the patient is pregnant, or if there is another compelling reason to continue monotherapy.

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Physician stage in practice: 
Resource Type: 
Description: 
This guideline offers guidelines on treating pregnant, substance-using women, with sections on Alcohol and Other Drug Treatment Guidelines for Pregnant, Substance-Using Women, Medical Guidelines for Pregnant, Substance-Using Women, and Legal and Ethical Guidelines for the Care of Pregnant, Substance-Using Women.
Source: 
U.S Department of Health and Human Services
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Description: 
This guide contains information for health care providers on the problem of drug-exposed infants and their families. Topics covered include medical management, followup and aftercare, psychosocial services, ethical and legal guidelines, and quality assurance.
Source: 
Center for Substance Abuse Treatment (CSAT)
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