Treating Opioid Use Disorder While Pregnant: Addressing Your Concerns While Expecting

April 2, 2024
Posted by Dr. Robert Sherrick

Opioid Withdrawal

Opioid Addiction Has Serious Effects On The Health of You and Your Baby

Pregnancy can be a special time, full of joy and anticipation. But for women struggling with an addiction to fentanyl or other opioids, it can be difficult and stressful. Every woman wants to be a good mother and do everything she can for her baby, but having to deal with an addiction makes it significantly more challenging.

Some women try desperately to stop all drugs by tapering or going “cold turkey,” but then they feel miserable, unable to eat or sleep well, and struggle with intense cravings. None of this is good for the baby! When women finally cave in and use drugs again, they feel guilty and shameful. They may be trying to hide their use from their friends and family, which only increases their stress and isolation.

In addition, women who have an active opioid addiction during pregnancy are more likely to deliver early, have smaller than average babies, and have complications with pregnancy. They are also far less likely to follow up regularly with their OB, making caring for a newborn much more difficult without the extra support and medical assistance.

Medication-assisted treatment is entirely safe for pregnant women

If you are pregnant and suffering from an opioid use disorder, there is hope. Medication-assisted treatment (MAT) can help treat your addiction and keep your unborn child safe.

The experts are unanimous: Women with an opioid addiction should receive MAT and stay on it during pregnancy. If a woman is already on MAT when she becomes pregnant, she should stay on MAT and not try to taper or stop her medication.

Continuing treatment produces the best outcomes for both the baby and the mother. The American College of Obstetricians and Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM) have agreed that this is the best course of action based on the best science and data available.

The benefits of MAT during pregnancy

Medication-assisted treatment can help women through this time and restore the special nature of pregnancy. By getting and keeping up with MAT during pregnancy, women can feel normal and have healthier babies. They no longer have to struggle with horrible withdrawal symptoms, intense cravings, and feelings of shame and inadequacy.

Babies born to women on MAT are much healthier. Medications used for treating opioid addiction are not associated with congenital disabilities, and babies grow and develop normally compared to other babies. Women on MAT can even breastfeed without fear of complications or passing harmful chemicals onto their newborns.

How does MAT work during pregnancy?

Your OB provider can refer you to a practice or clinic that provides MAT – with either buprenorphine (Suboxone or Subutex) or methadone. Any of these medications are appropriate during pregnancy, and your MAT provider can help you choose which one is best for you. Once you get stabilized on MAT, your withdrawal symptoms and cravings will go away, and you will feel normal without having to use any other drugs. Your OB and MAT providers can work together to help you through your pregnancy and delivery so that you have a healthy baby.

Can babies go through withdrawal from opioids?

Evidence suggests that during pregnancy, when the mother is having withdrawal symptoms, fetal movements increase, possibly indicating that the baby is having withdrawals in the womb. While on MAT, with all the withdrawals suppressed, babies can feel just as normal as their mothers. If the mother were to try to taper or stop all opioids, the baby would likely experience withdrawals in the womb, just like the mother does.

Once the baby is born, they will no longer be receiving the MAT medication from their mother – and infants can have withdrawal symptoms. This is called Neonatal Opioid Withdrawal Syndrome (NOWS). Babies may exhibit excessive crying, poor feeding, and fitful sleep. However, babies can be supported through this process and always get through it without long-term effects. 

Sometimes, simple measures such as breastfeeding, swaddling, skin-to-skin contact, low light, and a quiet environment calm the baby. In about half of all babies, low doses of medication (most commonly baby doses of morphine) are used on a tapering basis for a few days. While getting through this process may be stressful for the mother and family, it always has good outcomes, and the babies make it through just fine. The baby should have any withdrawal symptoms managed while they are out of the womb and fully formed rather than having them occur in the womb while they are still developing.

Should I just quit opioids cold turkey?

Even though women may be highly motivated to do the best for their baby, simply stopping all drug use is extremely difficult. The grip of an opioid addiction is so firm that willpower is not nearly enough. Nearly every woman needs MAT to help treat their addiction so they can have a healthy pregnancy.

If I’m already on MAT, should I taper my dose?

Studies have shown that the risk of NOWS is unrelated to the medication dose. They also show that attempting to taper off all medication does not decrease the frequency or severity of NOWS. The best outcomes are achieved by using the dose of medication that allows women to feel normal, without withdrawal symptoms or severe cravings, but also not too high so that they aren’t excessively tired or drowsy. In some cases, the dose has to be increased temporarily, usually during the third trimester, due to the faster metabolism rate associated with late pregnancy. 

Where can I find medication-assisted treatments?

At Community Medical Services, all our providers are trained and experienced in co-managing pregnant patients on MAT. We routinely work with OB providers to provide the best care for the mother and the baby. All you have to do is call or come into one of our clinics – we prioritize pregnant patients. We are dedicated to getting them on MAT as soon as possible, starting the day you walk in.

At Community Medical Services, we treat everyone with respect and dignity. You do not have to feel ashamed or guilty about coming into our clinics – you are doing the right thing for you and your baby when you do. Your medical provider will help you choose the proper medication for you and your baby and get you onto a stable dose as soon as possible. You will also talk to a counselor who can help you tackle underlying emotional causes linked to addiction and help you get ready to have a new baby in your life.

Get Medication Assisted Treatment at CMS

Community Medical Services is dedicated to helping individuals struggling with substance addictions reclaim their lives. We treat patients using a holistic method that focuses on both the physical symptoms of their addiction and the deeper psychological issues leading to it.

Our 70 clinics across the United States offer medication-assisted treatment programs featuring methadone, buprenorphine, and naltrexone to accommodate our patients’ needs better. We also offer counseling, peer support groups, and the resources you need to stay the course during your addiction treatment.

Find your nearest Community Medical Services clinic and book an appointment today. A brighter, addiction-free future is just a call or click away.

About the Author​

Dr. Robert Sherrick was appointed as CMS’s first Chief Science Officer in 2023, transitioning from Chief Medical Officer, a role he served for years.

Prior to serving CMS he had experience working at an inpatient addiction treatment facility in Montana, Pathways Treatment Center, treating all forms of Substance Use Disorders and dual diagnosis patients. Dr. Sherrick has been providing Medication Assisted Treatment for Opioid Use Disorder since 2003, initially in an office setting using buprenorphine and subsequently with methadone in Opioid Treatment Programs.

He established a state-wide buprenorphine treatment program for VA Montana with an extensive focus on telemedicine. He is board certified in Addiction Medicine through the American Board of Preventative Medicine and is the Immediate Past President of the Northwest Chapter of the American Society of Addiction Medicine.

Dr. Sherrick received his MS and BS degrees in Electrical Engineering from the Massachusetts Institute of Technology, and his MD from George Washington University Medical Center.

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