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PostPosted: Thu Feb 12, 2015 2:58 am 
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Thank you so much for your update! I am 5 months pregnant and have been on subutex for two and a half years. I take about 1-2 mg a day. It's not very much in comparison to what many dose daily, but it will still cause w/d in me if I were to quit! I have tried before and failed, never while pregnant though! Under all the impressions I've gotton it's not smart to quit while pregnant for the babies sake! I have been so worried to tell my obgyn so I haven't, and from what I understand they don't specifically text for Buprenorphine at the hospital from your or the baby, and unless your baby has signs of w/d they have no reason to poke around and test for more things! I'm very afraid of cps and my baby being taken away! I found out I was pregnant two months into pregnancy and couldn't quit at that moment. What I'm asking here is any information about the drug test that you and the baby are given at the hospital (I'm in ND of that helps)!? Any advice? Please nothing negative! I would taper off but my dose is so small already! &'I do not attain the drug legally because I do not have enough money for a subutex clinic or prescription! So that is another reason I do not tell my obgyn and why I'm terrifies of cps! Thanks for any words of advice or information about this topic! Please post if you have gone through something similar and if your baby had w/d or not!


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PostPosted: Thu Feb 12, 2015 12:36 pm 
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Hello Littlelane,
I am going to try and answer your specific questions. At our hospital urine drug screening is done if staff have a reason to be suspicious: such as history, previous ER visits, review of the state drug database or signs/symptoms of withdrawal in mom or child. I think sometimes they screen just because they think the person might be using. Slight diversion, my cousin in another state was screened because she had several tats and piercings. It is not routine for everybody.
Buprenorphine and its metabolite are part of our toxicology screen.
During the final trimester I don't encourage tapering as there may be an association with early labor. Sometimes more may be needed due to fluid distribution in the body.
You would need to stay on your usual dose to avoid withdrawal, if nurses see you in withdrawal, then every sneeze, cry, twitch the little guy makes will be a sign of withdrawal, whether he is or not.
good luck, docm


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PostPosted: Thu Feb 12, 2015 2:05 pm 
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Hi,
First, congratulations on your pregnancy! Pregnancy can be a beautiful time for a woman, but also stressful. Adding buprenorphine without support can make it even more stressful. I hope you find the information you need to ease your mind. I am also on subutex (appx 3mg/day) and am almost 34 weeks pregnant. I will be induced sometimes between March 9-16 so I can definitely relate to some of your concerns.

As for your specific questions, I do think it is individual for each state and hospital when it comes to drug testing. I do know that my hospital tests everyone at delivery because I live in an area that is rampant with prescription pill abuse and heroin use. Now whether they routinely use the 13 panel test that includes bupe is unknown to me. Because they know that I take subutex, they will automatically test the baby's umbilical cord for drug use as a precaution. Standard procedure here.

I don't say this to scare you, but even though you take only 1mg-2mg, baby can still have withdrawals. I just want to be upfront that I have heard of ladies on this small of a dose whose baby did have withdrawals. It is also a concern in my own situation. With that said, I think the risk is much lower than if you were on a high dose, such as 16 or 24mg. I recently discussed this with a local nursery/postpartum nurse who is also my home health nurse. I told her that some studies say that the dose is not linked to the likelihood of withdrawal and asked her personal opinion. She said in her experience only, this is untrue. She said that the higher the dose, the more likely infants in her care had withdrawal. Obviously this isn't pure science, but I took some comfort in it. Also, buprenorphine babies are less likely to have withdrawals than those on methadone or street drugs.

There are things that you can do to help make sure baby is comfortable after birth. If there are no other things preventing it (like HIV, for example), breastfeeding is great after birth for subutex babies. Not enough of the medicine is passed through breastmilk to completely prevent withdrawal, but all studies that I have read say that it is great for baby. Other things you can do is keep the room quiet and dark, swaddling, and kangoroo (skin-to-skin) care. I would do some research on NAS and know what to look for in the event that baby does have withdrawal. Even though we all hope it doesn't happen, rest assured that it is treatable if it does.

I wish that the medical community was more accepting of opioid maintenance therapy in pregnancy. I struggled with the decision of telling my doctor as well, but in the end, I did. I didn't have a prescription when I became pregnant but did end up getting one. For me, it was just less anxiety, but I understand why some women don't (cost, fear, cps, etc). I think if you are able to afford the subutex clinic and can find the medical support you need, it will help ease your fears. But I also know some women can't and I get it. Good luck! Hopefully some of this is helpful.


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
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