Journal of Addiction and Dependence | 2016-07-04

A Literature Review: Suboxone for Treatment of Opioid Dependence in Pregnancy and Lactation

Daphne Sharpe

Abstract

Background and Aims Opioid use during pregnancy can have detrimental effects on maternal and fetal outcomes. Guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the World Health Organization, recommend that pregnant women with opioid addiction be treated with methadone or buprenorphine. The opioid abuse epidemic in the United States has prompted the development and promotion of abuse deterrent formulations used to treat opioid dependence. Suboxone is a buprenorphine + naloxone (bup/nal) formulation that has lower abuse potential compared to buprenorphine alone. Bup/nal has shown better outcomes in the general population. However, little research exists on outcomes when used to treat opioid dependence during pregnancy. This review assesses current literature to compare neonatal outcomes following maternal treatment with methadone or bup/nal during pregnancy. Methods A search for keywords Suboxone pregnancy and breastfeeding in the PubMed Central (PMC) archive rendered 56 results, of which 9 were directly relevant to the prescription of bup/nal in the pregnant and breastfeeding population. Conclusions General consensus is that neonatal outcomes following bup/nal or methadone exposure in utero show no significant adverse neonatal outcomes. Neonatal abstinence syndrome (NAS) occurred less frequently among infants of mothers treated with bup/nal compared with methadone. All infants with NAS were treated postnatally with methadone. There was a trend toward shorter duration of treatment and lower cumulative dosages of methadone among the bup/nal exposed infants. Further prospective research is necessary to examine safety and efficacy of bup/nal for the treatment of opioid dependent pregnant women.

Keywords: suboxone, pregnance, naloxone