Treating Opioid Use in Pregnancy: Methadone and Buprenorphine

Is Suboxone or methadone used during pregnancy?

Yes — buprenorphine and methadone are the medications used to treat opioid use disorder, and treatment is generally continued during pregnancy under the care of an obstetric and addiction team. The three FDA-approved medications for opioid use disorder are methadone, buprenorphine, and naltrexone 1Ref 1Substance Abuse and Mental Health Services Administration (2021).TIP 63: Medications for Opioid Use Disorder — Full Document.That the three FDA-approved medications for opioid use disorder are methadone, buprenorphine, and naltrexone.. Taken as prescribed at a steady dose, methadone and buprenorphine relieve cravings and withdrawal without producing a high 2Ref 2National Institute on Drug Abuse (2024).Medications for Opioid Use Disorder.That methadone and buprenorphine relieve cravings and withdrawal without producing a high at therapeutic doses, and that treating opioid use disorder this way is not 'substituting one addiction for another.'.

The honest way to read the word "safe" here is as a comparison, not an absolute. No medication decision in pregnancy is risk-free, but neither is untreated opioid use disorder, which exposes a pregnancy to unpredictable substances and the chaos of the illness itself. That is why clinicians weigh steady, monitored treatment against those alternatives — and why the specifics of which medication and how it is managed belong with a care team who knows the pregnancy, not a general article. The real question is not "is the medication perfectly safe" but "is it safer than untreated opioid use disorder" — a comparison your care team makes with you.

Why stopping cold is usually not the answer

The instinct many people have — to just quit everything immediately for the baby — is understandable, but for opioid use disorder it tends to backfire. The national practice guideline recommends treating the disorder with methadone or buprenorphine rather than withdrawal management alone, and it advises against arbitrarily time-limiting the medication 3Ref 3American Society of Addiction Medicine (2020).The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder — 2020 Focused Update.That the guideline recommends treating opioid use disorder with methadone or buprenorphine rather than withdrawal management alone, and advises against arbitrarily time-limiting the medication.. Abrupt withdrawal has a high rate of return to use, and returning to unsupervised use is where the danger concentrates.

The evidence for staying in treatment is strong in general terms: being retained on methadone or buprenorphine is associated with substantially lower all-cause and overdose mortality than being out of treatment 4Ref 4Sordo L, Barrio G, Bravo MJ, et al. (2017).Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies.That retention on methadone or buprenorphine is associated with substantially lower all-cause and overdose mortality than being out of treatment.. Because withdrawal during pregnancy raises its own specific questions, those are worth taking directly to an obstetric and addiction clinician rather than acting on alone.

The guideline behind this is also explicit that medication should not be withheld from someone who is still using other substances 3Ref 3American Society of Addiction Medicine (2020).The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder — 2020 Focused Update.That the guideline recommends treating opioid use disorder with methadone or buprenorphine rather than withdrawal management alone, and advises against arbitrarily time-limiting the medication.. In practice that means the door to treatment stays open even when things are not perfect — disclosure to a clinician is more useful than waiting to be "clean enough" first, because the point of care is to move a pregnancy toward stability, not to require it as a condition of entry.

Methadone or buprenorphine — how the choice is made

Both methadone and buprenorphine are long-acting medications taken on a steady daily schedule, and both relieve cravings and withdrawal without the highs and lows of intoxication 2Ref 2National Institute on Drug Abuse (2024).Medications for Opioid Use Disorder.That methadone and buprenorphine relieve cravings and withdrawal without producing a high at therapeutic doses, and that treating opioid use disorder this way is not 'substituting one addiction for another.'. The choice between them is individualized — based on a person's history, what is accessible where they live, and how they respond — and it is made with the treatment team rather than from a list of pros and cons online.

The third medication, naltrexone, works differently and is generally not a first choice when the goal is to avoid withdrawal. It cannot be started until a person has fully completed opioid withdrawal, and that requirement causes more early failures and relapses at the point of starting compared with buprenorphine 5Ref 5Lee JD, Nunes EV, Novo P, et al. (2018).Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomised controlled trial.That extended-release naltrexone cannot be started until opioid withdrawal is complete, causing more early induction failures and relapse than buprenorphine-naloxone.. Because completing withdrawal first is exactly what treatment in pregnancy is usually trying to avoid, the two medications most often discussed are methadone and buprenorphine.

Am I just passing an addiction to my baby?

This is the fear that keeps people from getting care, and it rests on a misunderstanding. Physical dependence — the body adapting to a steady medication — is not the same as addiction, which is compulsive, harmful, out-of-control use. At a therapeutic dose these medications ease cravings and withdrawal without a high, and treating opioid use disorder this way is not "substituting one addiction for another" 2Ref 2National Institute on Drug Abuse (2024).Medications for Opioid Use Disorder.That methadone and buprenorphine relieve cravings and withdrawal without producing a high at therapeutic doses, and that treating opioid use disorder this way is not 'substituting one addiction for another.'. It is treating a chronic medical condition.

What a newborn may experience, how it is monitored, and whether any treatment is needed are questions for the obstetric and pediatric team, who plan for them in advance rather than being surprised by them. Those teams also discuss feeding and aftercare. Carrying that conversation into the delivery plan ahead of time is far more protective than trying to disappear the medication before birth. Staying in treatment and being honest with your care team is the protective choice — for you and for the pregnancy.

How treatment is accessed and kept steady

Access differs by medication. Methadone for addiction is dispensed through federally regulated opioid treatment programs, while buprenorphine can be prescribed in an ordinary medical or obstetric office and filled at a pharmacy. In 2024 a federal final rule expanded access to methadone treatment — including more flexibility for take-home doses and the option to start by telehealth 6Ref 6Substance Abuse and Mental Health Services Administration (2024).42 CFR Part 8 Final Rule.That methadone for addiction is dispensed through federally regulated opioid treatment programs, and that the 2024 final rule expanded access including take-home doses and telehealth initiation.. That flexibility can make it easier to keep treatment steady across a pregnancy and its many appointments.

Keeping the medication consistent matters more than almost anything, because gaps are where risk returns. Coordinating the addiction prescriber and the obstetric team — so both know the full picture — is part of what makes treatment work. For someone not yet connected to care, finding a buprenorphine prescriber early gives the pregnancy the longest runway of stable treatment.

Whether the dose needs any review over the course of a pregnancy is a question for the prescriber, and it is a routine part of managing the medication — handled by the clinician, never adjusted alone. What the evidence is clear about is that a steady, therapeutic dose relieves cravings and withdrawal without a high 2Ref 2National Institute on Drug Abuse (2024).Medications for Opioid Use Disorder.That methadone and buprenorphine relieve cravings and withdrawal without producing a high at therapeutic doses, and that treating opioid use disorder this way is not 'substituting one addiction for another.', and it is that steadiness that lets the rest of prenatal care happen on schedule rather than around a crisis.

What to bring to your care team

Because the specifics of medication for opioid use disorder in pregnancy are individualized, the most useful thing an article can do is name the questions worth asking rather than answer them for a body it cannot see. Honesty with the team is the foundation: they can only tailor care to what they actually know about, and disclosure is what unlocks a plan built around this pregnancy.

Worth raising directly: which medication fits this situation and why, how dosing may need to be reviewed across the pregnancy, what the plan is for delivery and the newborn, how feeding is handled, and how the addiction and obstetric teams will stay coordinated. These are the same evidence-based conversations that govern opioid use disorder treatment generally, applied to a pregnancy by the clinicians responsible for it 3Ref 3American Society of Addiction Medicine (2020).The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder — 2020 Focused Update.That the guideline recommends treating opioid use disorder with methadone or buprenorphine rather than withdrawal management alone, and advises against arbitrarily time-limiting the medication..