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PostPosted: Fri Feb 20, 2015 11:48 pm 
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Hi, I am new to this forum but I have loved it so far. I do have a question of my own because I want to make sure that I handle this right. I am 30 year old and 5 Months pregnant with my first child. I was addicted to any kind of pain killer, but mostly Oxycotin, for years. I was put on 16MG Suboxone films about 4 years ago but switched to Subutex when I got pregnant. I am currently taking 12MG total, 4MG 3 times a day. I hear a lot of back and forth on the subject of using Subutex while pregnant and about Neonatal Abstinence Syndrome (NAS) and I just want to do what is best for me and my unborn child. I don't even want to risk causing any harm to my child. I am in a very little town so their is no NICU (closest one is about 300 miles away) or specialists what so ever and we only have 2 pediatricians and of course no one in this town knows about Subutex, so as you could imagine, I am scared and need some direction. I would love to come off the Subutex but I can't get a definitive answer on how to do it or if it is even safe. I only have 4 months left before my baby is here so I don't have long and I want to do it so I don't have withdrawals. I am hoping for any kind of advice. I will be talking to my perscribing doctor about it as well but I don't think he even knows much about the drug. My OB knows I am on it but hasn't even asked or talked to me about it yet so I don't think he even knows about it so I don't know what to do or how to prepare him. If I don't get all the way off the drug should I go and deliver at the hospital that has the NICU just to be safe? Sorry for all the questions I just don't know where to start and I didn't even start on everything I would like to know. Thank in advance for any help or advice!


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PostPosted: Sat Feb 21, 2015 10:43 am 
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There are so many different perspectives on the issue, and I've written about most of them-- so to avoid repeating myself, please check out the web site [url]suboxsearch.com[/url] . You can search either the blog or forum; choose the section to search the blog, and enter 'pregnancy'-- you will find summaries about all the issues you are concerned about.

There is no way of tapering off buprenorphine (or any opioid) and having NO withdrawal. Lowering opioid tolerance requires going through withdrawal-- either mild withdrawal for months and months, or severe withdrawal for weeks. I never recommend going through the process during pregnancy. If you do, you will have less appetite, less sleep, and depressed mood-- all of which can cause problems for the developing baby.

On the other hand, if you get your dose of Subutex down to 4 mg per day, the baby is going to have minimal discontinuation symptoms, if any at all.

I prefer it when my patients go to hospitals that do not have neonatologists and nicus. At our small town hospital, women on buprenorphine simply deliver, go home on schedule, and breast feed-- which allows a natural taper off buprenorphine. Many hospitals with neonatologists have policies where babies are held for ten days, even if they appear to be fine. They argue that in some babies, withdrawal can present after a few days-- so they hold them just to make sure. My problem with that is that many studies have shown that it is very rare for withdrawal from buprenorphine to cause significant problems for a baby. I also see no sense in taking a baby who is experiencing minor, short-lived withdrawal from buprenorphine, and putting that baby on an opioid agonist that makes the withdrawal last longer!

Tough calls-- but check out the site I mentioned above, and you'll get at least my perspective on the issue.


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PostPosted: Mon Feb 23, 2015 10:05 am 
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Hi JD, if the goal is to get down to 4 mg/day, as suggested by Suboxdoc, that should be totally doable in your timeframe. I went from 8 mg/day down to 2 mg/day in well under two months, and it was absolutely pain free.

Subs withdrawals were not even noticeable until I hit about 1.5 mg/day.

During my earlier taper (from 8 to 2 mg/day), I think I was coming down at a rate of 1 mg/week -- hard to remember now, because I did this about a year ago. At your current dose, you might even manage a drop of 2 mg/week at the very beginning, though get some advice from your addiction doc about this first.

Good luck.

-- ji

P.S. I'm going to say this to anyone I talk to in the Stopping Suboxone subforum, in addition to planning to taper down or getting off of Subs completely, have you got any sort of recovery plan in place? It's really important, especially if you do plan to get off completely. Have you done any thinking about this?

_________________
"Past and future veil God from our sight; burn both of them with fire."
-- Rumi, Sufi poet and teacher


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Dr. Jeffrey Junig, M.D., Ph.D.

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