Suboxone is a medication used to treat Opioid Use Disorder (OUD) that combines buprenorphine and naloxone, which discourages misuse. Buprenorphine helps reduce cravings and withdrawal symptoms. When a person with OUD becomes pregnant, the decision to continue or start medication-assisted treatment (MAT) is a complex medical choice. Medical consensus establishes that managing OUD with medication is the recommended standard of care during pregnancy, stabilizing the mother’s health and providing a safer environment.
The Necessity of Medication-Assisted Treatment
Medication-assisted treatment for OUD is considered the standard of care for pregnant individuals because the risks of untreated OUD far outweigh the risks of medication exposure. Untreated OUD creates a highly unstable environment in utero due to repeated cycles of intoxication and withdrawal. This instability can lead to severe adverse outcomes, including maternal overdose and death, which is the leading cause of postpartum death. Fetal risks include poor fetal growth, placental abruption, and preterm labor. Suboxone provides a steady dose of medication, which stabilizes the intrauterine environment and leads to improved outcomes for both mother and infant.
Formulation Choice and Monitoring Protocol
Suboxone (buprenorphine and naloxone) is increasingly supported as a safe and effective treatment option during pregnancy. Historically, some clinicians preferred buprenorphine monotherapy due to limited data on naloxone’s fetal effects. However, naloxone has poor oral absorption and is primarily present to prevent injection misuse, meaning its systemic exposure to the fetus is minimal.
Recent large-scale studies show that the buprenorphine/naloxone combination is associated with similar, and sometimes more favorable, neonatal outcomes compared to buprenorphine alone. The choice between Suboxone and buprenorphine monotherapy is based on patient stability and diversion risk, but both are considered viable first-line options. Throughout the pregnancy, coordinated care is implemented, involving specialized obstetrical care, addiction medicine specialists, and behavioral health counseling.
Neonatal Opioid Withdrawal Syndrome
Neonatal Opioid Withdrawal Syndrome (NOWS) is an expected and manageable condition resulting from the fetus’s adaptation to chronic opioid exposure. Not every infant exposed to buprenorphine will develop NOWS, but a majority will show some signs of withdrawal after birth. Symptoms typically appear within the first few days of life, affecting the central nervous system, autonomic system, and gastrointestinal tract. Common symptoms include tremors, excessive crying, irritability, and difficulties with feeding and sleeping.
The severity and duration of NOWS symptoms vary widely depending on factors such as the infant’s metabolism. Most affected infants are managed effectively with non-pharmacological methods, known as the Eat, Sleep, Console (ESC) approach. The ESC model focuses on minimizing environmental stimuli, encouraging frequent feedings, and maximizing parental involvement through skin-to-skin contact. Only infants whose symptoms interfere with essential functions require pharmacological treatment, which is a short-term, tapered course of medication. NOWS is considered a temporary condition that does not cause long-term physical harm, though it often requires a longer hospital stay for observation.
Continued Treatment and Breastfeeding Safety
Continuing medication for OUD in the postpartum period is recommended to prevent relapse, which is a significant risk following delivery. Cessation of MAT can lead to a return to illicit substance use, placing the mother at high risk for overdose. Medical guidelines support maintaining the prescribed dose of buprenorphine or buprenorphine/naloxone after the baby is born.
Breastfeeding is encouraged for stable mothers taking buprenorphine. Only minimal amounts of buprenorphine transfer into breast milk, and the infant’s oral absorption is poor. The benefits of breastfeeding, including reduced severity of NOWS and enhanced bonding, outweigh the low risks of medication exposure. Infants exposed to opioids in utero are often recommended to have long-term developmental follow-up to monitor for potential impacts on behavior or development.