Suboxone and Pregnancy: What the Guidance Says

Finding out you are pregnant while you are on Suboxone brings a rush of questions, and the loudest one is often fear: is the medicine hurting my baby? The short answer from the doctors who set the guidance is no — treating your opioid use disorder with buprenorphine or methadone is the recommended path in pregnancy, and quitting on your own is the thing they warn against. Here is what each source actually says, and what to ask at your next appointment.

What the guidance says about staying on Suboxone

The relevant medicine here is buprenorphine, the active drug in Suboxone. Three of the organizations that pregnant people and their doctors rely on say the same thing:

• SAMHSA states directly that methadone and buprenorphine "are the safest medicines to manage OUD during your pregnancy."
• The CDC says that for pregnant women with opioid use disorder, medication for opioid use disorder is preferred over tapering off, and that it should be offered as early in pregnancy as possible.
• ACOG, the American College of Obstetricians and Gynecologists, recommends medication treatment and calls it preferable to medically supervised withdrawal.

On the safety question specifically, SAMHSA notes that current research shows no known increase in birth defects from buprenorphine or methadone, and that the benefits of treating the disorder outweigh the risks of leaving it untreated.

Why they discourage stopping suddenly

This is the part people are most surprised by. Stopping opioids abruptly or tapering in pregnancy is not the safer choice, and the guidance is blunt about why. ACOG writes that withdrawal is associated with high relapse rates, and relapse leads to worse outcomes for both parent and baby. SAMHSA's patient fact sheet puts it plainly: withdrawal "may make you more likely to start using drugs again and even experience overdoses."

The FDA's label for buprenorphine adds the physical reason. If the medicine is stopped suddenly in someone who is physically dependent, a withdrawal syndrome can occur. In pregnancy that is a strain on a body that is already working hard. So the guidance is not to white-knuckle through it — it is to keep the dose steady and talk to your team.

About neonatal opioid withdrawal syndrome

You have probably read about newborns going through withdrawal, and it is a real and frightening thing to picture. What the sources want you to know is that it is expected and it is treatable. The FDA label describes neonatal opioid withdrawal syndrome as "an expected and treatable outcome of prolonged use of opioids during pregnancy," and notes that, unlike withdrawal in adults, it needs to be recognized and managed by specialists.

SAMHSA adds something important about your dose: the amount of medication you take does not appear to affect whether your baby develops this syndrome or how severe it is. That means taking less to try to protect your baby does not help, and it can leave your own cravings and withdrawal uncontrolled. The guidance is to dose for stability, not for the nursery.

Monitoring is standard. The American Academy of Pediatrics recommends that babies exposed to opioids before birth be watched for a minimum of four to seven days after delivery, and your hospital team will tell you what that looks like for your baby.

Buprenorphine or methadone?

Both medicines are recommended, and the choice belongs to you and your clinician. ACOG points out some practical differences: buprenorphine involves fewer drug interactions, can often be handled through an outpatient office instead of daily clinic visits, and in several trials was linked to less severe withdrawal in newborns. SAMHSA notes the flip side — moving from methadone to buprenorphine can be very hard, which is why switching is a decision to make slowly and with your treatment team, not a snap judgment.

What neither source does is promise a particular outcome. This is a medical decision with real trade-offs, and it should be made with people who know your history.

What to ask at your next appointment

You do not have to become an expert on any of this tonight. You do need a few questions in your pocket:

• Is my current dose controlling my withdrawal and cravings? If not, what would you adjust?
• Who will manage my medication during pregnancy, and how do you two share notes — my prescriber and my obstetric team?
• What is the plan for monitoring my baby after birth, and who talks me through it?
• Is naltrexone an option for me? (SAMHSA notes it has not been studied in pregnancy.)

Write those down. Bring them. You are allowed to ask the same question twice.

What you can do tonight

If you are on Suboxone and pregnant, do not stop your medicine on your own before you have talked to the clinician who prescribes it. That single decision is the most important thing in this article. Call your prescriber or your obstetric office in the morning and say you are pregnant and need to review your treatment.

If you are pregnant, using opioids, and not yet in treatment, SAMHSA's National Helpline is free and confidential at 1-800-662-HELP (4357), and you can reach our team at (800) 653-9376 to talk through what treatment looks like during pregnancy. If you are in crisis, call or text 988. If you or your baby are in immediate medical danger, call 911.

Additional Resources

Sources cited on this page:

• SAMHSA: Treating Opioid Use Disorder During Pregnancy (SMA-18-5071FS2)
• SAMHSA: Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants (SMA-18-5054)
• ACOG Committee Opinion No. 711: Opioid Use and Opioid Use Disorder in Pregnancy (2017)
• CDC: Opioid Use and Pregnancy
• FDA: SUBUTEX (buprenorphine sublingual tablets) prescribing information

Common Questions