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Medications for opioid use disorder (MOUD), previously referred to as Medication-assisted treatment (MAT), involve the use of medications to manage opioid withdrawal, cravings, and the risk of relapse and overdose. MOUD using either buprenorphine or methadone is considered the most effective form of treatment for opioid use disorder (OUD), including for pregnant women. [1][3][5]
- MOUD, sometimes referred to as MAT, is an effective frontline treatment for opioid use disorder during pregnancy.
- Two FDA-approved OUD medications are safe for use during pregnancy: buprenorphine and methadone.
- MOUD during pregnancy significantly reduces serious risks, including maternal relapse and overdose, fetal distress caused by opioid intoxication and withdrawal, and birth complications related to opioid misuse.
Understanding MOUD during pregnancy
Pregnant women who struggle with opioid addiction are at increased risk of maternal and fetal complications. When left untreated, OUD during pregnancy can lead to preeclampsia, preterm delivery, fetal growth restriction, miscarriage, and even fetal death. Although MOUD during pregnancy carries some risks, these risks are far less serious than those associated with untreated OUD. [1][2][5][6][7]
The primary risk associated with MOUD during pregnancy is neonatal abstinence syndrome (NAS), commonly known as neonatal opioid withdrawal syndrome (NOWS), which can occur in babies exposed to opioids in utero. NOWS can develop not only in infants exposed to illicit opioids but also in infants exposed to MOUD medications, such as buprenorphine and methadone. However, in known exposure to MOUD, this risk can be managed with appropriate treatment after delivery. [1][3][6][7]
While the risks of NOWS are understood, the overall risks associated with MOUD are safer than those related to opioid withdrawal during pregnancy. Abruptly discontinuing opioids during pregnancy can result in fetal distress, preterm labor, and in some cases, miscarriage. [1][2][3][6][7]
FDA-approved MOUD medications during pregnancy
Two MOUD medications are considered safe and effective during pregnancy: buprenorphine and methadone. Both are FDA-approved medications that can significantly reduce cravings, alleviate withdrawal symptoms, and lower the risk of relapse and overdose. When taken as prescribed, these medications can also substantially reduce the likelihood of serious complications affecting the fetus. [1][2][4][5]
Why MOUD is the standard of care during pregnancy
While there are three FDA-approved MOUD medications, only two—buprenorphine and methadone—are approved for use during pregnancy. The third MOUD medication, naltrexone, has not been shown to be safe to use during pregnancy. [2]
The use of buprenorphine and methadone is aligned with the current clinical guidelines for the treatment of OUD during pregnancy. [5] A number of health authorities have endorsed the use of MOUD during pregnancy, including the Centers for Disease Control and Prevention, World Health Organization, Substance Abuse and Mental Health Services Administration, and the American College of Obstetricians and Gynecologists. These endorsements are backed by a large body of research, which suggests the use of buprenorphine and methadone during pregnancy can have the following effects: [1][3][4][5][6][7]
- Reduce illicit opioid use during pregnancy.
- Decrease cravings, withdrawals, and risk of relapse.
- Lower the risk of overdose and death.
- Improve treatment retention.
- Increase engagement in prenatal care appointments.
- Reduce the likelihood of high-risk behaviors, like IV drug use or needle sharing.
- Stabilize the health of the mother and fetus.
- Improve fetal growth and development.
- Reduce fetal distress related to withdrawals.
- Reduce the risk of preterm delivery.
- Lower the risk of miscarriage.
- Reduce the risk of low birth weight.
- Help mothers prepare for parenting.
Risks of untreated OUD during pregnancy
There are several serious risks associated with untreated OUD during pregnancy, including the risk of life-threatening complications for the mother and baby. Opioid overdoses claim more lives than any other type of drug overdose, and it represents the most serious risk for pregnant women abusing opioids.
In addition to the risks for the mother, there are also several serious risks to the baby associated with untreated OUD, including: [1][3][4][5]
- Risk for poor or inconsistent engagement in prenatal care appointments.
- Increased risk for inadequate nutrition.
- Increased risk for exposure to infectious diseases.
- Risk of fetal distress caused by cycles of opioid intoxication and withdrawal.
- Increased risk of preterm delivery, miscarriage, and stillbirth.
- Risk for poor growth and development.
- Risk for placental abruption.
MAT medication options: Buprenorphine vs. Methadone
Buprenorphine and methadone are the only two FDA-approved MOUD medications recommended for the treatment of opioid use disorder during pregnancy. [5] Each medication has been extensively studied and is considered to be a safe and effective option. Both medications work by reducing opioid cravings and withdrawal symptoms, reducing the risk of relapse. [2][3][5][6][7]
The choice between these two medications should be individualized based on a person's medical history, treatment needs, access to care, and personal preferences. One of the main differences between the medications is that methadone is a full opioid agonist that must be dispensed through an opioid treatment program, often requiring daily clinic visits. Buprenorphine, on the other hand, is a partial opioid agonist that can be prescribed for at-home use, making it more accessible and convenient for many patients. [4]
Some research suggests that infants exposed to buprenorphine during pregnancy may experience less severe symptoms related to NOWS, require shorter hospital stays, and need less medication for withdrawal, as compared with infants exposed to methadone. [6] Despite this benefit, methadone has a longer history of use and may be more appropriate for individuals who have more severe OUD, and it is linked to better treatment retention than buprenorphine. [3]
Importantly, both medications are associated with significantly better maternal and neonatal outcomes than ongoing withdrawal or no treatment. [6][7] Healthcare providers generally recommend continuing whichever medication was originally initiated, as switching treatments during pregnancy can increase the risk of withdrawal, relapse, and other complications. Ultimately, the best medication is the one that supports abstinence while promoting the health and safety of both the mother and baby. [1][3][4][5][6]
Accessing MAT during pregnancy
Healthcare providers who specialize in maternal health are well-versed in MOUD treatment options and should work with patients to help them access care. [1] If buprenorphine is recommended, it may be possible to receive a prescription from your provider if they are licensed to prescribe it. If methadone is recommended, your provider can provide a referral to an OTP clinic near you that offers this treatment. [4]
If you have health insurance, it may lower the out-of-pocket costs associated with MOUD treatment. The specific cost of these medications will depend on the details of your policy. Calling the number on the back of your insurance card or logging into the self-service portal to estimate costs and review coverage is the best way to determine your potential expenses. This is also the best way to locate in-network providers near you.
After finding a licensed and certified provider, the best way to initiate treatment is to call and schedule a substance use evaluation and intake. Usually, this process involves meeting with a licensed provider who can determine your diagnosis, assess the severity of your OUD, and recommend treatment options best suited to your individual recovery needs and goals.
