Suboxone In Pregnancy : Information for Patients and Providers
The American Psychiatric Association sponsors a new webinar on Suboxone in pregnancy. The webinars are primarily designed for healthcare providers, but have great value in answering questions about Suboxone and Buprenorphine to the person who is taking or is considering taking Suboxone (buprenorphine/naloxone) during pregnancy. I have previously written some information on suboxone in pregnancy.
I found this lecture very helpful from a medical perspective. Providers of Suboxone in pregnancy will find the information in the lecture invaluable. The lecture is clear, to the point, and contains updated information on prescribing suboxone in pregnancy. I think the video could easily be understood by most anyone.
I will note that Suboxone is a combination medication of buprenorphine and naloxone. Because of risks in pregnancy using naloxone, buprenorphine is usually used alone during pregnancy. The brand name for buprenorphine alone is Subutex.
Suboxone In Pregnancy : The Lecturer
Marjorie C. Meyer, M.D.
Associate Professor, OB/GYN
Director, Division of Maternal Fetal Medicine
University of Vermont School of Medicine
Key Topics Covered In Suboxone In Pregnancy Video
-Pregnancy initial visit
Assemble treatment team
Plan for newborn evaluation and care
Plan for pain control/delivery
Plan for post partum treatment
Other Key Ideas Discussed in the Suboxone In Pregnancy Video
It is not recommended to wean women of Suboxone in pregnancy after 32 weeks pregnant, if at all during the pregnancy period. The risk of relapse and subsequent risks to the patient and the fetus usually outweigh the risks of continuing treatment. Other risks included going to jail, IV drug use, and not getting proper prenatal care. The benefits of continuing suboxone in pregnancy (including buprenorphine and methadone) include: improved birthweight, improved retention in a program and abstinence, and improved chance of keeping the child in the longer term.
Methadone and buprenorphine both caused neonatal abstinence syndrome, but it appears less so with buprenorphine.
-closely supervised induction (starting) buprenorhpine in preganacy is not harmful to the fetus.
-before starting suboxone in pregnancy (with buprenorphine alone in pregnancy discussed) one should always obtain a fetal sonogram
-followup for suboxone in pregnancy or buprenorphine in pregnancy should be every 1-2 weeks.
-If a patient if receiving counseling outside the office, it should be confirmed
-Usually no further medication changes are necessary after 32 weeks as the changes in the pregnant female’s body have slowed. The lecturer’s experience indicates only a 4 to 6mg change is usually necessary (increase) during the pregnancy
-Epidural analgesia is effective while taking buprenorphine
-CRITICAL: nALBUPHINE AND BUTORPHANOL ARE CONTRAINDICATED as both can precipitate withdrawal in methadone or buprenorphine maintained patients. The OBGYN will REQUIRE a reminder from you; reasonable to remind the patient as well.
-the addition of IV and oral narcotics such as oxycontin are discussed. The generally used amounts used during vaginal delivery and C-section is covered.
-Breastfeeding recommended unless HIV positive
-Postpartum: keep maintenance dose the same
-difficulty with compliance occurs at about 3months postpartum
-THERE IS USUALLY MORE BENEFIT HAVING THE PATIENT QUIT SMOKING THAN TO GET OFF BUPRENORPHINE OR SUBOXONE IN PREGNANCY.
More Resources on Suboxone in Pregnancy
If you feel you need help and are looking for a doctor who prescribes Suboxone, click here for our buprenophine physician registry. If you think you may need more intensive treatment such a methadone detox, other opioid detox, or getting started on buprenorphine inpatient, click here for our state opioid treatment center registry.