Opioid Use Disorder Treatment
- Clinicians should advise their patients to avoid abrupt discontinuation of opioids, including buprenorphine (BUP) or methadone, during pregnancy because of the risks posed by withdrawal or resumption of unhealthy use (i.e., heroin) following abstinence. (B2)
- When offering pregnant patients BUP treatment or referral to an opioid treatment program (OTP) for methadone treatment, clinicians should discuss the maternal and fetal risks and benefits of both medications (see Table 1); the treatment choice should be based on patient preference whenever possible. (A3)
- Clinicians should educate patients who take opioids, BUP, or methadone during pregnancy about the risk of neonatal opioid withdrawal syndrome (NOWS), an expected and treatable outcome (see Neonatal Opioid Withdrawal Syndrome section of this guideline). (A3)
- Clinicians should inform patients that breastfeeding while taking BUP or methadone is safe and may reduce the risk of NOWS. (A2)
- Clinicians should not recommend naltrexone initiation, which requires withdrawal from opioids, for a pregnant patient who is actively using opioids. (A2)
- If a pregnant patient is abstinent from opioids and requests treatment with naltrexone, clinicians should discuss naltrexone as an alternative treatment and inform the patient of the associated risks and benefits. (A3)
- Clinicians should inform patients who become pregnant while taking naltrexone of the risks and benefits and preferred pharmacologic treatment options (see Table 2: Benefits and Risks of Continuing or Stopping Naltrexone During Pregnancy). (B3)
- See the NYSDOH AI guideline Treatment of Opioid Use Disorder > Implementing Opioid Use Disorder Treatment.
- Before initiating BUP in a pregnant patient with OUD, clinicians should confirm that the patient is experiencing at least mild opioid withdrawal symptoms (B3) and should consult with an experienced substance use treatment provider regarding the risk of precipitated withdrawal. (A3)
- Clinicians should advise patients who initiate BUP or methadone during pregnancy, and those who become pregnant while taking BUP or methadone, to continue treatment throughout pregnancy, labor, delivery, postpartum, and breastfeeding. (A2)
- At each visit, clinicians should monitor pregnant patients taking BUP for opioid cravings and withdrawal symptoms and, if present, increase the dose as appropriate for the individual and reassess at the next visit; any dose increase should be maintained until treatment goals can be evaluated postpartum. (A3)
- If taking a dose of 32 mg BUP mg daily does not allow the patient to meet treatment goals, clinicians should recommend methadone treatment. (A3)
- If a pregnant patient is considering a change from methadone to BUP, the clinician should consult an experienced substance use treatment provider because of the risk of precipitated withdrawal. (A3)
