Key takeaway
You are pregnant and thinking of stopping methadone, buprenorphine, alcohol, or a benzodiazepine at home to protect the baby. That stop can be the more dangerous hour. Tell the prenatal clinician and the addiction clinician tonight. Do not quit alone. Methadone or buprenorphine stays in place unless those clinicians change it.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
You are pregnant, and you are thinking of stopping the medicine or the drinking tonight so the baby will be safer. That stop can be the more dangerous hour. Tell the prenatal clinician and the addiction clinician. Do not quit methadone, buprenorphine, alcohol, or a benzodiazepine alone.
If you have a seizure, cannot breathe, collapse, or become severely confused, call 911. For a mental health crisis, call or text 988.
Do not stop the opioid medicine to protect the baby
Quickly stopping opioids in pregnancy is not recommended, because it can bring preterm labor, fetal distress, or miscarriage. A treatment plan can improve the chance of a healthy pregnancy. Current recommendations favor medication over supervised withdrawal, because medication is more likely to produce better outcomes and a lower risk of relapse. Methadone and buprenorphine are the first-line medicines, together with behavioral therapy and medical care.
Neonatal abstinence can follow that medicine. Worry about it should not keep the prescription from being written. Babies can be watched and treated. Hiding the pregnancy, or quitting the medicine in secret, is not the protection it feels like. Signs in the newborn are covered in neonatal opioid withdrawal.
Opioid agonist treatment is preferable to medically supervised withdrawal, because withdrawal is tied to high relapse rates and worse outcomes. If you do not accept an agonist, or none is available, supervised withdrawal can be considered by a physician experienced in perinatal addiction, with your informed consent. Success with that path often takes a long inpatient stay and intensive outpatient follow-up. It is not a weekend at home, and it is not a plan to be off everything before the first prenatal visit.
Continue the medicine after birth. At a minimum, do not stop in the early postpartum period. A taper, if one is considered, waits until the baby is consistently sleeping through the night, breastfeeding has ended, and you and the baby are stable and housed safely. Any later taper is slow, supervised, and paired with a plan if opioid use returns. People stay on these medicines for months or for many years. Care after delivery is in postpartum substance use care. How the medicines differ is in medication for opioid use disorder.
Methadone and buprenorphine are compatible with breastfeeding. Only minimal amounts pass into milk, and breastfeeding can ease newborn withdrawal. Untreated opioid use disorder in pregnancy is associated with poor prenatal care, malnutrition, early birth, low birth weight, and withdrawal in the newborn. Naltrexone is not first-line. Safety information is limited. If you are already stable on it, that limited evidence is weighed against the risk of relapse if it is stopped. Do not start or stop it on your own.
Alcohol and benzodiazepines are a different stop
There is no known safe amount of alcohol in pregnancy, no safe time, and no safe type. The risks CDC names include miscarriage, preterm birth, stillbirth, sudden infant death, and fetal alcohol spectrum disorders. Not every baby is affected. It is never too late to stop. If you drank before you knew you were pregnant, stop now, get prenatal care, and tell the child's clinician.
Seizures and delirium tremens can cause death or disability when no one is providing medical care. Pregnancy does not make an unsupervised stop safer. Tell both clinicians how much you have been drinking. Who needs a medical setting is in detox at home versus medical care.
Stopping a benzodiazepine abruptly, or cutting the dose too fast, can cause seizures. That warning still applies while you are pregnant. Bring the bottle, or the name of the medicine, to a clinician who can plan any change.
Ask whether the program is in the funded system
Programs paid with substance use block-grant funds must give pregnant women preference in admission. If a funded program has no bed, it refers you to the state, and interim services, including a referral for prenatal care, are supposed to be available within 48 hours. Interim services are not a residential bed. The rule does not bind a private program that does not take those funds. Ask which kind you are calling. FindTreatment.gov is one place to look, and then you still ask.
Programs covered by 42 CFR Part 2 have extra federal limits on telling someone you are a patient. What consent covers is in privacy and confidentiality. Obstetric clinicians are asked to discourage separating parents from their children solely because of a substance use disorder. State child-welfare rules still differ. Staying away from care to hide the pregnancy is not the safer path.
Keep naloxone where you can reach it if opioids are in the house. If breathing stops, use the steps in opioid overdose signs.
Call or text (800) 653-9376 if you need a program that will talk with your prenatal clinician instead of asking you to quit alone.
Additional Resources
Sources cited on this page:
- CDC: Treatment of opioid use disorder before, during, and after pregnancy
- CDC: About alcohol use during pregnancy
- ACOG Committee Opinion 711: Opioid use and opioid use disorder in pregnancy
- NIDA: Medications for Opioid Use Disorder (pregnancy and breastfeeding)
- eCFR: 45 CFR 96.131, treatment services for pregnant women
- SAMHSA TIP 45 quick guide: Detoxification and Substance Abuse Treatment
- FDA: Boxed warning on benzodiazepines
- eCFR: 42 CFR Part 2, Confidentiality of Substance Use Disorder Patient Records
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Should I stop methadone or buprenorphine because I am pregnant?
No. CDC says quickly stopping opioids in pregnancy is not recommended, because it can bring preterm labor, fetal distress, or miscarriage. Methadone and buprenorphine are first-line treatment, together with behavioral care. Continue the medicine after birth. A later taper, if one happens, waits until the baby is consistently sleeping through the night, breastfeeding has ended, and you and the baby are stable and housed. It is slow, supervised, and paired with a plan if opioid use returns.
Will the baby have withdrawal if I stay on the medicine?
Neonatal abstinence can follow medication treatment. CDC says worry about that alone should not keep a clinician from prescribing the medicine. Babies can be monitored and treated. In research NIDA cites, infants of mothers treated with buprenorphine were less likely to have neonatal opioid withdrawal syndrome or low birth weight than infants of mothers treated with methadone. That comparison is not a prescription for you. Naltrexone is not first-line. If you are already stable on it, the limited safety evidence is weighed against the risk of relapse if it is stopped.
Is any amount of alcohol safe while I am pregnant?
CDC says there is no known safe amount, no safe time, and no safe type, including wine, beer, and liquor. Alcohol in pregnancy is associated with miscarriage, preterm birth, stillbirth, sudden infant death, and fetal alcohol spectrum disorders. Not every baby is affected, and it is impossible to know which baby will be. It is never too late to stop. If you drank before you knew, stop now, get prenatal care, and tell the child's clinician. Do not quit heavy daily drinking alone.
Do treatment programs have to admit a pregnant person first?
Programs funded by the substance use block grant must give pregnant women preference. In programs that treat injection drug use, the order is pregnant people who inject, then other pregnant people, then other people who inject, then everyone else. If a funded program is full, it refers you to the state. Interim services, including a prenatal referral, are supposed to start within 48 hours. Interim services are not a bed. A private program outside that funding follows a different rule. Ask which system you are calling.
Does going to treatment mean I will lose my child?
ACOG says obstetric clinicians should discourage separating parents from their children solely because of a substance use disorder, suspected or confirmed. State child-welfare laws still differ, and a notification after a birth is not the same thing in every state. Staying away from care to hide the pregnancy is not what these sources recommend. Ask the program what a release allows it to tell a partner or a parent.