As I’ve mentioned, I was at a ‘summit’ about buprenorphine in Washington DC earlier this week.  I didn’t hear anything earth-shaking at the meeting, but will share a couple things that I learned there over the next few posts. 
One night I was reviewing messages in my hotel room and I received an e-mail from a person saying that Social Services took her baby away from her at the hospital because she had delivered on buprenorphine.  The baby was essentially being held hostage by the hospital under Social Services orders, and was being treated, against her wishes, with opiates to avoid opiate withdrawal.  I had a patient a year or two ago who had a similar experience, where her baby was placed on a morphine drip against her wishes, after she delivered while on buprenorphine.  These stories really make me angry.  The literature contains case reports and even studies about buprenorphine in neonates, so why would a doctor do something so foolish, as treat withdrawal from a partial agonist using a full agonist?  The literature already suggests that neonatal abstinence syndrome is milder after buprenorphine than after methadone, and there are articles that have been out for several years describing the use of buprenorphine during pregnancy.  So how can a neonatologist act as if the mother is doing something abusive?
One of the more interesting speakers at the buprenophine summit had preliminary data from a study of NAS (neonatal abstinence syndrome) in babies born to mothers on methadone vs. those on buprenorphine.  The NAS scores that looked at infant behavior were not significantly different from one another, but the doses of PRN opiates used to treat NAS (morphine in this study) were ten-fold greater in the methadone group than in the buprenorphine group.  The lesson from the study is that much lower doses of morphine are needed to block withdrawal from buprenorphine than from methadone, in neonates from mothers on the substances. 
My own opinion takes things a bit further.  The studies found that the NAS scores were similar in both groups. The study was blinded, i.e. the nurses who scored the amount of withdrawal did not know which substance the mother was taking.  But the nurses DID know that the mothers were taking one or the other–  and from experience, it is clear that mothers known to be opiate addicts are viewed with scorn from the nursing staff in the average delivery suite.  I often receive messages from mothers describing varied forms of ‘tsk tsk’ every time their baby burps, even as the other babies in the nursery scream all night long.  So I take the NAS scores with a big helping of salt.  I suspect that once identified as an ‘addict’s baby’, the nuances of the baby’s NAS were masked by a general attitude of disdain toward the mother, and blurred by sympathy for the newborn for having been born into such a dire situation.
As this and other reports find their way to publication, one can only hope that OB teams and neonatologists will READ the publications, and realize that buprenorphine treatment does not require a report to child safety services, and does not automatically call for a week of intravenous morphine for the newborn!


SPOTTER · May 16, 2010 at 3:55 pm

I have treated two patients who were on subutex and delivered normal babies. None of them were treated with medication although both of their pediatritians had them nursing. The babies did well and no evidence of withdrawal were seen. I called two of the babies pediatritian and he noted no problems and the babies left the hospital at the usual time.
One of the patient’s has now delivered two babies without any prob lems. The nursery don’t know what subutex is and the patient used very small amounts of subutex frequently to handle post delivery pain.

    SuboxDoc · May 17, 2010 at 11:09 am

    Thank you very much for your comments.

babymama · October 13, 2010 at 12:23 pm

I have a question.I have been subscribed subuxone for a year now and I’m due to have my baby in 8 days.Iam down to 1mg a day.Will my baby be born with withdraws?

gigi · January 2, 2011 at 8:13 pm

I delivered in April of 2009 after being on Subutex for my entire preganancy at a dosage of 4 mg/day. I was treated just fine at the hospital by the staff (thank God) and my baby boy was just perfect. He had not a single symptom of NAS. I tend to believe your theory about the nurses knowing these were “addict babies” and that they jumped at each sniffle, yawn, etc. There are just too many stories out there just like mine where baby does not have ONE SINGLE SYMPTOM! Therefore I find it hard to believe that each baby in the study had NAS to one degree or another. That being said, it is very positive and happy news to see that Sub has been proven to be superior to Methadone for neonates, hopefully the science will help move things along as far as bringing Sub into the light for some of these ill-informed doctors and addicted pregnant women as well. Thank you! · January 14, 2011 at 9:36 pm

I have a 20mth and during my pregnancy took 8mgs sometimes twice a day and honestly did not know there could be any problems. my dr before being pregnant said he had never heard of anything from suboxone harming a fetus or newborn. I stopped seeing him due to the cost but continued on suboxone. Three days after my son was born they said he was experiencing withdrawls and without even asking me started him on morphine every 3hrs. I never said anything for so many reasons ,it has haunted me ever since and after a week and begging to take him home he was released.The next day ws seen by his ped. and was said to be completely normal and couldnt believe what happened at the hospital. My son is fine . I am now pregnant again and trying to get off scared of the same thing and cant tell anyone because of before. If i get off 3 to 4 mths before birth does anyone know can my baby still hve withdrawls? I am not a stupid person and would never intentionally hurt my child, I just can not tell my family or the hospital. If anyone has any info please help. Thank you.

mspero · February 19, 2011 at 8:11 pm

My baby boy is a week old and is still in the Nicu. While i was pregnant i was on 8 mg of subutex because i was addicted to percacet. As i read the other comments i can really relate, to how the nurses judge me and i feel like they givc him points just to make his score go higher. They have him on the morphine and i want them to start weaning him, just want him to go home, his muscle tone is really tight but that is the only thing i see. Other things they score him for are things that all normal babies do. I just wish i knew how long he is going to have to be here. If anybody has any advice on how to make him more relaxed i would love to get some feedback, and thanks for all the other comments i have read!

mummy webster · May 11, 2011 at 7:02 am

I am 6 weeks pregnant and currently on 2.4mg of buprenorphine. what are the chances of my baby suffering from NAS at this dose?

    SuboxDoc · May 20, 2011 at 7:41 pm

    Studies show that only about 50% of babies on buprenorphine show any NAS, and the ones that do have mild symptoms– certainly a very low level of discomfort, compared to having your head squeezed so hard that the shape changes!

mlboysen · August 13, 2011 at 4:25 pm

Hi. My baby is 6 weeks old and I was on subutex for the duration of my pregnancy. I was on a dose of 24 mg subutex during my pregnancy and was on 32mg of suboxone when I became pregnant. My doctor and I felt that, for me, staying on the medication was the best choice. I had concerns that my child would suffer NAS but my doctor, who had prior experience with pregnancy and subutex, reassured me that my child would have very mild to no symptoms. My baby was born healthy at 8lbs 4oz. He suffered absolutely NO withdrawal symptoms. It was amazing. I breastfed immediately and roomed in with the baby. He was monitored closely by my pediatrician every day for 2 weeks and no symptoms occurred. He slept and ate well consistently and was very calm. Now at almost 6 weeks he is 11lbs 9oz. I don’t know if this response is too late for you, but I just want to let you know that it is definitely possible for your child to suffer no NAS regardless of when and how much you taper. I read alot of mixed info on the internet and believe that if you are healthy and on no other drugs besides the subutex, your child will be healthy. I also made sure to educate both my OB/GYN and pediatricians ahead of time and made sure that we were on the same page. I did a lot of research during my pregnancy and wanted to avoid my child being put in the nicu or given opiates for no reason.
I hope this helps everyone.

Kerri · April 8, 2017 at 9:23 am

I was coming off suboxone when I found out I was pregnant (I was also on prozac for depression). My Dr informed me that we had to put a hold on the tappering down process, due to the facts of causing great harm to the unborn fetus. My Dr informed me that we had to switch to subutex and that I had to stay on the prozac for fear that my depression would worsen from the increases of hormone levels when pregnant.I was all on-board with that plan and was reassurred that my baby would be okay. My prenantal appointments were showing all great signs, but I was still assigned as a “high risk pregnancy”. My daughter was 2 weeks late and they induced me with potocein. The labour was long, painful and felt like it was never going to end. I was in labour for 36 hrs and pushed for 4hrs. The contraction were really painful not so much in the lower abdominal area, but I had back contractions as well and that was brutal. They gave me 2 epidurals and nothing was making the pain subside (I think taking the suboxone had a lot to due with the epidural not working). After, 40 hrs of labour I begged for a c-section and I went off to the O.R. where my daughter made her grand entrance.. When she came out of the womb she was smiling, not crying and she was hypertonoic. Right away red flags raised by 72 hrs they told me they put her on morphine drip and that her scores were high.. I begged and pleaded with them not to put her on it please… She acted like any other baby that was born but because of my honesty they put her on this. I forgot to mention that the meconium test, as well as, the urine test was negative for all substances including subutex. So, please tell me why they gave her morphine and singled her out as different?? 6 weeks they kept her in the nicu, six weeks of complete stress for her father and myself and trying to keep it quiet and not telling both sides of the families. My blood pressure was so high they admitted me back into the hospital, I spiked a 104.0 fever and I had dehiscence (my staples from the c-section opened up).. I felt like a horrible mother. Long story short my daughter is 2 years old now, no problems at all.. In fact she is above all kids her age with counting, knowing the full alphabet, and is the most loving, caring, beautiful little girl ever…

    Jeffrey Junig MD PhD · April 8, 2017 at 12:37 pm

    If you read my many comments about pregnancy, you’ll see that I’m frustrated by the treatment of newborns of mothers on buprenorphine. THe buprenorphine/Suboxone did not affect the epidural; epidurals use local anesthetic that is not blocked in any way by buprenorphine (or naloxone). I used to do epidurals on a daily (and nightly!) basis during the ten years that I was an anesthesiologist. Whether it worked or not depends on the skill of the anesthesiologist, and a couple factors related to the mother (whether she can hold still, the amount of weight gain, etc).
    All newborns lack myelin coating of their nerves, so spasticity is normal. And in any nursery, some babies are crying all the time, and others sleep all day. Buprenorphine is blamed for both– either the baby is ‘too awake’ and irritable, or ‘too sleepy’ and sedated!
    Fever and dehiscence are also not related to buprenorphine– although it is harder to treat the pain of surgery and surgical complications in people on buprenorphine medications.
    I’m glad things worked out eventually. Many studies have shown that opioids to not lead to long-term changes in development. And yes, going into withdrawal during pregnancy is NOT a safe thing to do.
    Congratulations on your baby!

H · July 21, 2017 at 11:21 am

I am currently taking 24 mg and sometimes more of Subutex. I have severe chrohns disease and it helps to control my bowels as well as the pain instead of pumpin my body with other toxins that do not work and only make me more sick. I am currently 8 weeks pregnant and desperately wanting to have a healthy baby with a safe delivery. Has anyone had experience taking this dosage of Subutex and their baby having no side effects or withdraw?

    Jeffrey Junig MD PhD · July 24, 2017 at 7:52 pm

    Because of the ceiling effect, your baby won’t have any greater risk of withdrawal at higher doses of buprenorphine than at lower doses– about 50% risk. But the metabolites of buprenorphine cause constipation without effects at the brain– so you are getting some extra help from Crohns from those higher doses of buprenorphine. I don’t see any major problems from taking the extra– and it is probably helping you feel better.

      H · July 26, 2017 at 6:01 am

      You are so very right on every point. It’s so hard for some people to understand. Thank you for easing my mind

Please don't use your real name unless you want it to show. Thanks for commenting!!

This site uses Akismet to reduce spam. Learn how your comment data is processed.