Is Breastfeeding While on Suboxone or Buprenorphine/Naltrexone Safe?


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Addiction to opioid drugs has exploded in the past few years. Today, the opioid addiction crisis has reached epidemic proportions and has been declared a national emergency in the U.S. Up to three-fourths of all people currently addicted to heroin started down the path of opioid addiction after taking a legal, prescription opioid. One of the reasons why addiction to heroin and other opioid drugs has increased is because they are widely available. Taking an opioid prescription is a common occurrence after suffering an acute injury, recovering from surgery, or dealing with chronic and severe pain. The fact that a drug is a legal prescription does not mean that it is non-addictive. Unfortunately, while opioid drugs are highly effective at treating pain, they are also incredibly addictive. 

Opioid addiction strikes men and women in roughly equal numbers, but women who are addicted to opioids face particular barriers to treatment and other complicating factors that can make recovery difficult and more challenging. For one thing, pregnancy is not a cure or prevention for substance use disorder. Since 2000, there has been a 500% increase in the number of pregnant women addicted to opioids. Opioid addiction can also stop menstruation and mask the symptoms of pregnancy. A woman can be severely addicted to opioids and not know she is pregnant for several months. While the societal stigma surrounding drug addiction is something all people with substance use issues face, the stigma is more pronounced for pregnant women and mothers of breastfeeding infants. 

Babies born to women who are addicted to opioids and have not received care for addiction are at increased risk of SIDs, low birth weight, and other health problems. But women who get treatment, including the use of prescription opioid maintenance medications, experience improved health outcomes for their babies. 

Can pregnant women use Suboxone or Buprenorphine/Naltrexone?

When a pregnant woman abuses opioids, the chemicals in these drugs are carried through the bloodstream and directly impact the developing fetus. Flooding the body with heroin, or powerful prescription opioids causes dramatic fluctuations in the level of opioid chemicals in both the mother and the fetus’s bloodstream. Also, experiencing withdrawals while pregnant can have the opposite effect, causing the substances to decrease dramatically. It is not recommended that pregnant women go through withdrawal and detox when addicted to opioids. Instead, doctors recommend that pregnant women receive maintenance medications. 

The goal of using these medications is to keep blood levels stable so that the growing fetus won’t be subjected to wild fluctuations of opioid chemicals. Using opioid replacement drugs while pregnant also prevents the mother from going through withdrawals, and diminishes cravings for dangerous opioid drugs. While administering replacement opioid medications can lessen the severity of a baby being born with Neonatal Abstinence Syndrome (NAS), medications like Suboxone or Buprenorphine/Naltrexone won’t wholly diminish the risk. Babies born to mothers who take these replacement medications as directed can still give birth to a baby with NAS. 

Is it safe for breastfeeding mothers to take drugs like Suboxone or Buprenorphine/Naltrexone?

There is very little data on humans suggesting whether or not Suboxone is safe to use for breastfeeding mothers. But research on Buprenorphine/Naltrexone has found that it improves health outcomes for babies. Buprenorphine/Naltrexone use while breastfeeding is associated with reduced frequency and severity of NAS symptoms in newborns. Physicians generally encourage breastfeeding for mothers who are undergoing treatment for opioid addiction, as long as they abstain from illicit substances. 

Studies on replacement opioid agonist drugs have found that clinically insignificant levels of the drugs pass through breast milk, and these findings suggest that regardless of the dose of any of these drugs given to the mother, the use of these drugs is safe for breastfeeding infants. Doctors who are experienced with addiction during pregnancy frequently prescribe replacement medications to mothers and also encourage breastfeeding for neonates. The well-known dangers associated with continued abuse of opioid drugs while pregnant and breastfeeding are believed to outweigh the risk of exposing an infant to medications like Buprenorphine/Naltrexone and Suboxone in breast milk. 

Can these drugs harm a developing fetus or a breastfeeding baby?

All pregnant women need prenatal care. But for those who are also struggling with an addiction to opioids, prenatal care must also include treatment for addiction. In most cases, treatment plans will consist of medications like Buprenorphine/Naltrexone or Suboxone. This is different than what is usually recommended for non-pregnant people recovering from opioid addiction. For these patients, detox is usually the first step in the recovery process. But this is often dangerous for the developing fetus. Research has also found that mothers who use replacement opioid medications can help their breastfeeding babies with NAS. These medications can reduce the severity and duration of NAS symptoms.

Unfortunately, relapse is a significant risk factor during recovery from drug addiction. It is crucial that breastfeeding mothers who relapse stop giving breast milk to their infants. Implementing alternative feeding methods is imperative to the health and safety of the infant. 

What help is available for pregnant and breastfeeding mothers addicted to opioids?

Studies on opioid addiction and pregnancy have found that opioid maintenance for pregnant and breastfeeding mothers is safer and more effective than opioid withdrawal and detox without medical assistance. These studies have found that women who receive Buprenorphine/Naltrexone-assisted withdrawal and maintenance treatment were more likely to stay in recovery treatment programs for longer, and they were also more consistent in attending prenatal appointments and obstetric appointments after giving birth. Many hospitals offer antenatal and postnatal care and delivery options alongside drug addiction treatment for pregnant and nursing mothers. 

If you or a loved one is struggling with drug abuse and addiction, it’s never too late to reach out for help. The addiction specialists and counselors at Windward Way have helped dozens of patients recovery for substance abuse and alcohol addiction. Please contact Windward Way today to learn more about how their treatment options can help you achieve and maintain sobriety.