Treating Opioid Use Disorder During Pregnancy

Pregnancy and Opioid Abuse

It has been estimated that maternal opioid overdose rates have grown dramatically from 1996 to 2014, showing a 4-fold increase during that time. Approximately 6.5 of every 1,000 births involve a mother with an opioid use disorder.¹ This trend of opioid use among pregnant women is distressing for many reasons. Opioid use during pregnancy can have serious consequences for both mothers and their unborn children. Mothers may experience preeclampsia, a dangerous pregnancy complication characterized by high blood pressure and protein in the urine.² Dangers for the fetus and newborn child include:³

• Poor fetal growth.
• Stillbirth.
• Premature birth.
• Birth defects.
• Neonatal abstinence syndrome (NAS), in which the child is born physically dependent on opioids and goes through withdrawal.

When pregnant women take opioids, there are many possible consequences for their children’s development, which experts do not completely understand. Children with NAS are thought to be somewhat more likely to have speech delays or developmental delays.³

Can Medications Treat Opioid Use Disorder During Pregnancy?

What can a woman do if she has an opioid use disorder and is pregnant? Research on treating pregnant women who are dependent on opioids has been used to create guidelines that reflect best practices in treatment. The American Society for Addiction Medicine (ASAM) recommends medication-assisted treatment, particularly with methadone or buprenorphine, to help treat pregnant women with opioid use disorder.² 

Methadone is a synthetic opioid that has been used to treat opioid use disorders since the 1960s and generally has only minor side effects. In some people, methadone can cause heart complications. If a person takes too much of it or mixes it with other sedating drugs, such as alcohol or benzodiazepines, overdose can occur.⁴ Methadone controls cravings for opioids and blocks the effects of other opioids.⁴ Methadone is a recommended treatment for pregnant women with opioid use disorders.⁴ However, despite helping the mother with an opioid use disorder, and being relatively safe for her unborn child, children born to women who have been taking methadone can develop NAS.⁴

Buprenorphine is also recommended to treat opioid use disorder in pregnant women. Buprenorphine has similar outcomes for women with opioid use disorders, but is better for unborn children, resulting in fewer incidents of NAS.⁵

Overall, the risks of continuing opioid addiction in pregnant women greatly outweigh the minimal risks involved in using methadone or buprenorphine.² The use of any medication-assisted treatment for pregnant women should also include behavioral therapy and coordination with their medical provider who is providing prenatal care.⁶

While some treatment programs do offer supervised withdrawal from opioids without medications, the combination of medication-assisted treatment and behavioral therapy is recommended, as it results in better overall treatment outcomes and fewer women dropping out of treatment. Should a pregnant woman decline psychosocial treatment, she can still benefit from methadone or buprenorphine.³

What About Suboxone?

You may have heard of another medication known as Suboxone, which is a combination product of buprenorphine and naloxone used for medication-assisted treatment. Naloxone is typically used to reverse an opioid overdose. It is added to buprenorphine as a deterrent to misuse.

Should a person attempt to inject Suboxone into their bloodstream, the naloxone will block the effects of opioids.⁷ There is a lack of comprehensive research on the safety of Suboxone and other buprenorphine/naloxone combination products for pregnant women. The updated 2020 guidelines from the American Society for Addiction Medicine, however, mentions that it is frequently used and considered safe and effective for use in pregnant women, although the authors also acknowledge that further research is warranted.²

Risks of Untreated Opioid Use Disorder in Pregnancy

If a woman does not get treatment for an opioid use disorder and continues to abuse opioids while pregnant, there are many risks involved for both the mother and the unborn child.

For the mother, a primary concern is an overdose. If a pregnant woman injects opioids, she also runs the risk having HIV and hepatitis which can complicate pregnancy.²

Children born to mothers with opioid use disorder are at risk for premature birth, stillbirth, low birth weight, and potential developmental delays later on.⁸ Neonatal abstinence syndrome (NAS) is also a concern. The symptoms of NAS are:³

• High-pitched crying.
• Hyperactive reflexes.
• Loose stools.
• Poor ability to suck.
• Seizures.
• Sleep issues.
• Trembling.
• Vomiting.
• Yawning and sneezing.

NAS is treatable, with doctors typically using either methadone or buprenorphine in tapered doses to help the infant overcome NAS symptoms.⁹

Newer approaches to treating NAS include options like “rooming-in” where infants stay in the room with their mothers rather than going to a NICU. Rooming-in encourages mother-child contact, including breastfeeding.¹⁰

Does AAC Treat Pregnant Women for Substance Abuse?

At American Addiction Centers (AAC), our facilities offer leading-edge substance abuse treatment in a medically supervised setting. We offer programs for pregnant women to help manage opioid withdrawal in safe environment for you the mother and her unborn child. Give us a call at There, you can learn more about your treatment options and next steps to recover from your opioid addiction.

Getting help and treating an OUD is important to protect both the pregnant mother and child from the potential outcomes of opioid use, including maternal overdoses and a range of negative outcomes for the infant.

Buprenorphine and methadone are the 2 most commonly used medications to control cravings for opioids and can be used effectively to treat pregnant women. Any risks from using buprenorphine or methadone are far lower than the risk of continuing to use opioids while pregnant.

Sources

1. Centers for Disease Control. (2018). Opioid use disorder documented at delivery hospitalization. United States 1996-2014.
2. American Society for Addiction Medicine. (2020). National practice guideline for the treatment of opioid use disorder.
3. Centers for Disease Control. (2020). Opioid use during pregnancy.
4. SAMHSA. (2020). Medications for opioid use disorder.
5. Edge, R., and Butcher, R. (2019). A review of comparative clinical effectiveness, safety, cost-effectiveness, and guidelines.
6. Centers for Disease Control. (2020). Treatment of opioid use disorder before, during, and after pregnancy.
7. National Institute on Drug Abuse. (2020). Opioid Overdose Reversal with Naloxone (Narcan, Evzio).
8. Centers for Disease Control and Prevention. (2020). Opioid Use During Pregnancy.
9. Wachman, E. M., Minear, S., Hirashima, M., Hansbury, A., Hutton, E., Shrestha, H., Combs, G., Barry, K., Slater, C., Stickney, D., & Walley, A. Y. (2019). Standard Fixed-Schedule Methadone Taper Versus Symptom-Triggered Methadone Approach for Treatment of Neonatal Opioid Withdrawal Syndrome. Hospital Pediatrics, 9(8), 576–584.
10. Klaman, S. L., Isaacs, K., Leopold, A.,Perpich, J., Hayashi, S., Vender, J., Campopiano, M., & Jones, H. E. (2017). Treating women who are pregnant and parenting for opioid use disorder and the concurrent care of their infants and children: Literature review to support national guidance. Journal of Addiction Medicine, 11(3), 178–190.