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PostPosted: Mon Apr 14, 2014 8:34 pm 
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Hi All

At some point, I'm going to be trying to get pregnant. I'm on a low dose of Suboxone, around 1 - 1.5mg/day. I'm not even sure if that tiny amount would make it to the baby....but I'm nervous. What do you all think? I don't want the baby to go thru any kind of withdrawal or discomfort. So, I'm tempted to come off the Suboxone in preparation, or, during the pregnancy, at a very gradual rate. (I know that its unsafe to come off quickly.)

I also wonder how much, if any, Suboxone passes through in breastmilk. From what I'm reading, its little.

I also take .5mg of clonazepam about 4-6 times/month for acute anxiety. I would try to cut that out altogether.

And yes, I know that I should talk to my doctor but honestly he's actually extremely uneducated on these matters (just shows you how easy it is to get the waiver to prescribe Sub) and I guarantee that if I went to him with these questions, he would tell me that I had to come off the Suboxone or switch to methadone if I want to get pregnant.

Any thoughts?


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PostPosted: Tue Apr 15, 2014 2:04 pm 
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Buprenorphine is a very potent opioid, and was used in microgram doses to treat pain in past decades-- 100 micrograms as a typical dose. One mg is equal to 1000 micrograms-- so the dose you are taking is low by 'suboxone' standards, but is still a significant amount of opioid.

That said, I've had many, many patients have babies on buprenorphine or Suboxone, and it is uncommon to see signs of neonatal abstinence when the mother is on 4 mg or less of buprenorphine per day. Of course, if the nurses KNOW you are on buprenorphine, they tend to see symptoms whether they are there or not.

I urge you to google 'suboxone talk zone' and 'guilt trip'-- to find a post I wrote about how the symptoms experienced by a baby, from buprenorphine, compare to the other things babies routinely deal with-- like a digestive system that isn't fully innervated, the discomfort of having one's head squeezed into a cone shape, being tied down and circumcised without anesthesia, etc.

Yes-- buprenorphine is in breast milk, in very small amounts. I usually have patients breast feed; any tiny amount that makes it past the baby's liver might help taper off buprenorphine... but the usual situation is a baby who looks and acts normal, and breast-feeding that has no effect other than the usual comfort that babies have during breast-feeding.

Buprenorphine has not been shown to have effects on fetal development. Benzos, though, have been linked to increase risk of miscarriage. The standard of care for opioids, more and more, is to put women on buprenorphine, since it has lower abstinence symptoms than methadone. The standard of care for benzos is to stop them during pregnancy.

Finally... check out my site at www.suboxsearch.com . You can search my blog, or this forum, using the word 'pregnancy'-- and find dozens of things I've written over the years, some of which include links to research findings on pregnancy and buprenorphine.

Good luck!


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PostPosted: Thu Apr 17, 2014 9:37 pm 
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Thank you SO much. You have no idea how much better this makes me feel.


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PostPosted: Tue Apr 22, 2014 12:47 pm 
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Hello thisagain, I just want to say I understand where you are at.. Been thinking about trying to have another child myself.. I have done alot of research as you should too... Not everyone is so lucky... As a personal choice I choose to not start trying until I have completed my taper and jumped. Only you can make that choice. All I know is that I have read stories where some woman were told the baby was totally fine and they were on a low dose and then after birth they were at the hospital 2 plus weeks. Then I have read where some ladies never had an issue. I had a dr. who was not honest with me. Suboxone was a great tool to help me restart my life and I will never say otherwise but I dont' agree when people claim there are no side effects. Every drug has side effects... Is it better than being addicted to opiods? Sure is! No doubt about that, also alot easier to taper and come off of. I agree but just keep all options open. I think your doign a great job coming here and asking questions. That tells me that you really are worried about the possible health of your baby. Hopefully you can decide what you want to do and good luck with everything!!


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PostPosted: Sat Jun 07, 2014 2:05 pm 
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So, guess what? I am pregnant, everyone! :) This is great news. :)

I started off the pregnancy at 1.5mg/day, but, really, I can feel well with less. (I know that sounds weird, but I've never had a high tolerance for long-acting opioids.) Ironically, a week before I found out I was pregnant, my maternal instincts must have kicked in, because I stopped taking the Klonopin and I cut the Suboxone dose down to 1mg/day. Crazy, huh?

I've now cut down to .75mg, as of about two weeks ago. I feel "okay". I am tossing a turning a bit, feeling restless, waking up too early, eyes tearing before I dose, yawning, that kind of thing. So its not that I FEEL BAD, but its just like annoying. I can't really say how my sleep would be if I WEREN'T pregnant. I don't know what to blame it on. I've been taking 400mg of magnesium at night to sleep, and occasionally (maybe once/week), taking it during the day as well for anxiety. My OB said that this was fine.

My plan is to stay on this .75mg another week or so (no set-in-stone timeline, because I won't go down so soon if I feel like crap), and then I will cut down to .5mg/day. Then .25mg/day, and so on. I'm also not opposed to dosing every other day towards the end, or to taking a .25mg piece if I've been off for a week or so and feel really awful, and so on. I'm being very realistic and kind to myself, considering the circumstances.

I am very confident, recovery-wise, that I can handle this. In actuality, out of the last twelve years, I've only been "not sober" for about a month. I had two slips with painkillers, one about a week, and another maybe three weeks. I just got on the Suboxone because I know maintenance works for me, and I didn't want to risk a full-blown relapse.

I'm not terribly concerned with how this would affect my baby, either, and that's only because of the information I've gotten on here regarding low-dose Suboxone, and the information I've read online that basically reflects that very little of the mini-dose of Suboxone would make it to the baby anyway. I'm figuring that I'm taking such a small amount that the amount the baby is getting would be possibly nothing at all.

I feel very determined to come off of this at least three months prior to my due date in January. I live in an area that is not "recovery-friendly" and I am terrified that I would end up with Children's Services at my house, or something like that, if the hospital where I am giving birth found out I was on Suboxone. Most people are not going to believe, or care, that I've been clean for twelve years, except a total of a month; I don't want to be discriminated against. If I feel like my recovery is shaky after I have the baby, I'm not opposed to getting back on Suboxone. But that remains to be seen. I'm not ruling anything out.

Anyway.....support and feedback is definitely welcome! :)


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PostPosted: Fri Jul 11, 2014 6:12 am 
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hello im currently due for surgery in 3 weeks to have my daughter.. i take 1-3 mg a day of soboxone.. i know it effect the epidural so i hear.. i was wondering if someone can help me with some questions.. how soon befor my surgery date should i stop the soboxone? my ob doesnt kno ive takin the subs.. an want it out of my system by 3 weeks.. he also prescribed me pain meds to start takin now.. so if i want to stop the subs an start takn the pain med dose he recomended 1 pill every nite for siactica nrve pain how long should i wait after stoping the subs? an will i not feel any withdrawls for the remainder 3 weeks till surgery. me stoping the subs and startn the prescription will that keep me from withdrawling while pregnant. ive been so worried i dont wanna have it in my system.. at least the pain med my ob prescribed me is prescribed id rather them see that in my system instead of something they dont kno about.. after surgery i plan to quit everything. i dont want to continue the subs or any pain meds.. i figured i wont b pregnant any more so im goin to go for it.. if anyone can help me plz.. telling my doctor about the soboxone isnt an option i wanna take.. thnx


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PostPosted: Fri Nov 21, 2014 5:47 pm 
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suboxdoc wrote:
Buprenorphine is a very potent opioid, and was used in microgram doses to treat pain in past decades-- 100 micrograms as a typical dose. One mg is equal to 1000 micrograms-- so the dose you are taking is low by 'suboxone' standards, but is still a significant amount of opioid.

That said, I've had many, many patients have babies on buprenorphine or Suboxone, and it is uncommon to see signs of neonatal abstinence when the mother is on 4 mg or less of buprenorphine per day. Of course, if the nurses KNOW you are on buprenorphine, they tend to see symptoms whether they are there or not.

I urge you to google 'suboxone talk zone' and 'guilt trip'-- to find a post I wrote about how the symptoms experienced by a baby, from buprenorphine, compare to the other things babies routinely deal with-- like a digestive system that isn't fully innervated, the discomfort of having one's head squeezed into a cone shape, being tied down and circumcised without anesthesia, etc.

Yes-- buprenorphine is in breast milk, in very small amounts. I usually have patients breast feed; any tiny amount that makes it past the baby's liver might help taper off buprenorphine... but the usual situation is a baby who looks and acts normal, and breast-feeding that has no effect other than the usual comfort that babies have during breast-feeding.

Buprenorphine has not been shown to have effects on fetal development. Benzos, though, have been linked to increase risk of miscarriage. The standard of care for opioids, more and more, is to put women on buprenorphine, since it has lower abstinence symptoms than methadone. The standard of care for benzos is to stop them during pregnancy.

Finally... check out my site at http://www.suboxsearch.com . You can search my blog, or this forum, using the word 'pregnancy'-- and find dozens of things I've written over the years, some of which include links to research findings on pregnancy and buprenorphine.

Good luck!



I'm 33 weeks and currently down to 1/3 (0.333)mg daily, but tapering has been much more difficult that I anticipated. (I've been on bupe for 10 years). Taper went fine until I got to 28 weeks pregnant and down to 0.75mg- I don't know which milestone made things so tough. Despite the
slow taper (began pregnancy at 6mg), 0.75 to 0.5 mg has been aweful (even though I stretched that out over 5 weeks and 0.67mg in between). Now at 1/3 mg daily (I break up a 2mg subutex into 6 pieces, approx. 0.333mg each) I'm in constantly in mild w/d. I take the 1/3mg broken up into 3 doses-a teeny crumb every 8 hours- which I have in one of those weekly pill organizers. The problem is that I feel ok for only a few hours after each dose, then slowly go into withdrawal after 6 hours- my pupils literally turn into flying saucers, I sweat, my leg muscles go crazy and I lose my mind. My prescribing physician pretty much leaves it up to me, but advises against tapering. He just doesn't care either way, and says if baby has NAS, it'll be ok.

My ob also says its up to me, but if I don't taper off completely, baby must be held for 5 days in nicu for observation and will likely be medicated. I know all the statistics, at worst my baby has a 50/50 chance of chowing signs of NAS. I feel like because I'm in a small town, where there is no difference between methadone and suboxone according to what the ob docs know, they will automatically medicate my baby. I've read many horror stories and know the nurses' scoring will be prejudiced.

I want to just tell them that I'm weaned off completely when I'm not (even though my script is legal) but I am aware that if I lie and they find out, things will only be worse! I just want go back up to 0.75mg or even 1mg and go back to living my life- I work part time as a nursing assistant and have 3 awesome kids, age 2, 9, & 13 (who care for alone while hubby is deployed), and have made a pretty awesome life that I credit to 10 years sobriety that buprenorphine has given me. I'm so conflicted its making me crazey. I just wish I had a doctor who knew all the real statistics and would medical staff who would treat me like a good Mom instead of "some addict" who's baby is suffering because of my own weakness. I'm so miserable and scared- I don't know which is worse, the stigma I'll suffer if medical staff know I'm taking subutex when my baby is born, or the withdrawals and the next 7 weeks without the subutex. Both options suck!

Jamie B.

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There's no such thing as regret; there's what you do and what you don't do.

God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.


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PostPosted: Fri Nov 21, 2014 6:25 pm 
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I truly feel for the situation you find yourself in Jamie. It does suck! It's so great that you've had 10 years of happy sobriety, and a good experience with using buprenorphine as part of your recovery, and I'd encourage you to continue to take a sufficient dose to keep you and baby from experiencing withdrawal. This is meant to be a precious time of immense joy in a woman's life. At the small doses you're taking now, buprenorphine acts like a full agonist, hence feeling wd symptoms and the need to take a dose every 6 or so hours. Being in and out of a constant state of withdrawal, as I'm sure you know, can't be good for you or your baby. Inadequate rest, hydration, nutrition and anxiety could cause a myriad of issues for baby, not to mention you feel terrible. Imo, and I'm no doc, but I would go back to a comfortable dose, and enjoy the rest of your pregnancy. Even if others aren't so understanding, you'll know you're doing what's best for you and your baby by treating your illness with a safe and proven effective medication.

Of course, I can't say for sure that your newborn won't have any NAS symptoms, but on a low dose like 1 mg, it's likely they wouldn't be significant enough to warrant medication. I understand your concern and apprehension about hospital staff, but be a fierce advocate for you and baby. Demand to be present when he/she is scored on the Finnegan scale so that you can observe the symptoms the nurses say your baby has, and if something doesn't seem right to you, speak up, go over anyone's head that you must. This is your right. Breastfeeding is your right, and is great for babies with or without NAS, the minute amount of buprenorphine in your breastmilk could help, but the closeness to mom is what's most beneficial if baby truly has wd.

Above all, hold your head up high, you're doing the right thing! Addiction is a disease, deserving of appropriate and effective treatment. women that have other conditions have the right to have children, and do all the time. Some are even commended for having their babies despite their illnesses. The double standard is unfair and is largely due to ignorance on the part of so called medical professionals. Right now, imo, the best thing we can do to combat the stigma associated with MAT and pregnancy, is to be as educated as possible, and prove those who would judge us wrong. I hope that no matter what decision you make, you feel good about it, and all goes well for your family.


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PostPosted: Fri Nov 21, 2014 6:49 pm 
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Lizzieshug,
Thank you for your reply. Its what my heart is telling me to do, though the fear has been keeping me in this withdrawal misery for the past 5-6 weeks. Going back up to 0.75 - 1mg, I would feel normal again, begin enjoying my kids and my pregnancy again, and just go back to trying to stay as healthy as possible while getting ready for our new baby. I've been keeping myself from doing that because I didn't want to "ruin all the progress" of getting down to as low of a dose as I have.

I'm curious about what you said:
" At the small doses you're taking now, buprenorphine acts like a full agonist, hence feeling wd symptoms and the need to take a dose every 6 or so hours."

What does that mean, "full agonist"? I've done soooooo much research recently on the 'half life' of buprenorphine, but it was actually just a few days ago on suboxonetalkzone where I did read that doses as small as 0.5 or less need to be broken up because they "wear off". I didn't really understand, I honestly just thought it was psychosomatic- being that at my normal dose (for the last 10 years) of 6-8mg, I always split up my daily dose in 2-3 doses because I seemed to feel more "even" that way, (and my suboxone-prescribing physician told me it was fine cut my daily strip/ break my pill to divide my dose if it helps me). I figured that it was just my addict mind playing tricks on me- that I couldn't truly be in withdrawal after 6 hours! But the handful of times I've takes most of my dose early in the day and forced myself to go 12 hours until my dose the next day, my pupils are HUGE and wd symtoms are hard core. I still don't understand why with half life being what it is.

Thank you again for your support and encouragement!!!
Jamie B

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God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.


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PostPosted: Fri Nov 21, 2014 8:02 pm 
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Before buprenorphine was used to treat opioid addiction, it was and still is used as a pain medication in micro gram doses, where as in addiction it's used in much larger milligrams doses. It is called a partial agonist opiate because there is a limit to its effects after a certain blood level of the drug is achieved. So that taking more bup will have no more opioid effects. This is what makes buprenorphine so effective and unique for treating opiate dependence, and contributes to its increased safety compared to full agonist opiates. This is referred to as the ceiling effect. In those small microgram doses used for pain, the ceiling effect doesn't exist basically and it acts as a full ag opiate. In other words you're not taking enough bupe for your blood level to remain above the ceiling for the entire dosing interval, causing you to feel wd every few hours as your blood levels decrease. There's no feeling of anything coming coming on or wearing off like we experience when we take full agonist opiates such as oxycodone, hydrocodone, heroin etc. when it's taken in sufficient doses to treat opioid addiction. I hope that helped. It's sort of a tough thing to explain. Dr. Junig does a great job of explaining it at http://www.suboxonetalkzone.com. if you use the search feature, and enter the words ceiling effect, you should find articles with detailed information and graphics to demonstrate the ceiling.


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PostPosted: Fri Nov 21, 2014 11:35 pm 
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Thanks Lizzie! I just want to stress also that buprenorphine does NOT cause problems/interact with an epidural. There was a time when anesthesiologists used spinal narcotics instead of local anesthetic, but that technique caused a great deal of nausea and fell out of favor. Current epidurals use local anesthetic, which is NOT affected by buprenorphine or opioid tolerance-- whether used for labor or for C-sections.

I have to plug the page http://www.suboxsearch.com too-- where you plug in the word 'pregnancy', for example, and get all sorts of info from the blog or forum. Good luck with your baby-- you've gotten good advice form the other comments.


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PostPosted: Fri Nov 21, 2014 11:59 pm 
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Thank you for your responses! This all helps so much to put my mind at ease. I'm going to get back up to a dose where I feel comfortable and remain there and do my best to educate my health care professionals if necessary so that I can have a smooth delivery in January:)

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God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.


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PostPosted: Sat Nov 22, 2014 9:22 am 
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Good for you. Do what's best for you, you're the one who has to live in your body, so you know best how you feel. I've said this before, but I believe it holds true for sure in your situation, for some people, it becomes a quality of life issue, and if you felt better physically, mentally and emotionally while taking your medication, then take it. You deserve to be healthy and well. I do hope you're able to enjoy the remainder of your pregnancy, and start to feel better very soon. Please do keep us updated!


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PostPosted: Sat Nov 22, 2014 10:09 pm 
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Thank You! I took 0.75mg today (after taking 0.333mg for the last few days) and I feel so much better. I had a good day at work, and was able to come home and clean up my house a little and cook dinner for my kids (no fast food, YAY!). I'm still super uncomfortable and I'm now hurting quite a bit from being on my feet & super busy today, but I'm not withdrawing on top of all that:) So I'm gonna take some Tylenol and get myself to bed as soon as I get the kids settled down.
I'm still sooooo super nervous to talk to the ob-gyn next Thursday, but I'm glad I see the nurse practicioner that day, she's much more sympathetic and supportive than the 4 doctors are (they just kinda bustle in then out as quickly as possible). I feel like maybe she'll be a little easier to talk to, and maybe she can answer some of my questions about the hospital and their protocol with subutex Moms, because that's what scares me the most. Anyway, better day today:) I'm going to continue to look thru the Suboxone and Pregnancy Board, because having this support and people who understand (&& know what they're talking about) helps A LOT!

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God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.


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