Subutex vs Suboxone in pregnancy: which is safer?

If you're pregnant and considering medication-assisted treatment (MAT) for opioid use disorder (OUD), or you’re currently in treatment and wondering whether to continue your medication, the advice you'll hear can pull you in different directions. When you’re making decisions about your health during pregnancy, conflicting guidance can make it hard to feel confident about your next step.

This article gives you a clear, evidence-based breakdown of Subutex® vs Suboxone® in pregnancy. You’ll learn what current research says about outcomes for your baby, how providers choose an appropriate medication, and how to have an informed conversation with your care team about which option is right for you.

Subutex vs Suboxone in pregnancy: key similarities + differences

Both Subutex and Suboxone contain the same active ingredient: buprenorphine, a partial opioid agonist that helps reduce opioid cravings and withdrawal symptoms. Buprenorphine binds to the same brain receptors as opioids but activates them less intensely. This decreases cravings and withdrawal symptoms without triggering feelings of intense pleasure.

The brand-name Subutex is no longer marketed in the U.S., but generic buprenorphine-only formulations are still widely used and often referred to as “Subutex.”

So, how do Subutex and Suboxone differ? While they’re both effective in treating OUD, the primary difference is that Suboxone includes naloxone and Subutex does not. Naloxone is an opioid antagonist that blocks opioid effects by binding to the same receptors without activating them. This antagonist is added to buprenorphine because it triggers withdrawal if injected, helping to deter misuse. When Suboxone is dissolved under the tongue and taken as prescribed, the naloxone is mostly inactive.

The buprenorphine-naloxone combination can be helpful for individuals managing OUD during pregnancy. However, some providers debate whether this "extra" ingredient is necessary or potentially harmful to the developing fetus.

Why MAT is recommended during pregnancy

Experts, including the American College of Obstetricians and Gynecologists (ACOG) and American Society of Addiction Medicine (ASAM), recommend medication-assisted treatment for the management of opioid use disorder in pregnancy. MAT is preferred over medically supervised withdrawal, which carries relapse rates ranging from 59% to over 90% and is associated with worse outcomes.

Before prescribing medication for OUD, your healthcare provider should:

• Confirm that opioid treatment is appropriate
• Obtain your substance use history
• Review your treatment goals
• Discuss risks and benefits with you
• Check your insurance coverage

Why abstinence-only is not recommended

Attempting to stop opioid use abruptly while pregnant can introduce significant risks, such as:

• Preterm labor
• Fetal distress
• Maternal relapse
• Miscarriage

MAT helps reduce these risks by stabilizing opioid levels in your body.

Where Subutex + Suboxone fit within MAT

Both ACOG and the Substance Abuse and Mental Health Services Administration (SAMHSA) recommend either methadone or buprenorphine—the primary ingredient in Subutex and Suboxone—as first-line MAT options for pregnant individuals with OUD. 

Methadone may require daily visits to a specialized clinic, but buprenorphine-based medications like Subutex and Suboxone offer flexibility. With clinical evaluation and ongoing monitoring, these medications can be prescribed through telehealth like Ophelia, for at-home use. 100% virtual treatment allows you to avoid daily clinic visits and get treatment that fits easily into your everyday life.

Safety + outcomes in pregnancy

Maternal outcomes

Research consistently shows that mothers on buprenorphine-only or buprenorphine-naloxone have similar outcomes regarding birth weight, preterm birth, and respiratory symptoms. The most important factors for a healthy pregnancy are stability and avoidance of illicit opioids.

However, when it comes to buprenorphine vs methadone in pregnancy, buprenorphine shows better outcomes for newborns than methadone.

Is naloxone safe in pregnancy?

When taken as prescribed, naloxone is minimally absorbed and unlikely to reach your baby in meaningful amounts. Current studies on buprenorphine-naloxone show no adverse effects and similar outcomes when compared to buprenorphine alone. 

Some providers still prefer buprenorphine-only out of an abundance of caution, while others prescribe Suboxone without concern. Both approaches are clinically acceptable.

Neonatal abstinence syndrome (NAS): what to expect

What is NAS?

Neonatal abstinence syndrome (NAS) refers to withdrawal symptoms some newborns experience after birth due to in-utero opioid exposure.

Common NAS symptoms include:

• Poor feeding
• Increased muscle tone
• Jitteriness or tremors
• High-pitched crying
• Irritability
• Vomiting or diarrhea
• Yawning, sneezing, or nasal stuffiness

These symptoms may begin within 24–48 hours or up to 5–10 days after birth. Initial treatment starts with simple, non-medication approaches like skin-to-skin contact and frequent feedings. However, some babies need medication to treat severe withdrawal symptoms.

Babies with NAS experience symptoms for 20 days on average, though some may require shorter or longer monitoring and support. Most infants respond well to appropriate care and treatment.

NICU + hospital planning

Research shows that rates of admission to the neonatal intensive care unit (NICU) are higher among babies who develop neonatal opioid withdrawal syndrome (NOWS). However, buprenorphine use does not automatically mean your baby will require NICU admission. Other factors play a role, like whether your infant develops withdrawal symptoms and how your hospital manages opioid-exposed newborns.

After delivery, your newborn may be monitored for signs of withdrawal for 4–7 days if no medication is required, or for 24–48 hours after stopping medication.

Many factors determine when your infant is ready to be discharged:

• Resolution of withdrawal symptoms
• Adequate feeding and weight gain
• Establishment of a care plan, including outpatient follow-up

Discussing your birth plan with your care team in advance can make the entire postpartum period smoother.

Which medication is typically prescribed during pregnancy?

Suboxone vs Subutex in pregnancy is a provider-guided decision based on:

• Current treatment stability
• Insurance coverage
• Patient preferences
• Patient intolerance/sensitivities
• History of IV misuse

Neither medication is universally preferred. The best treatment is the one that considers your clinical history, keeps you from using illicit substances, and allows you to fully engage in your prenatal care.

Breastfeeding while on buprenorphine

Current guidance encourages breastfeeding for people taking buprenorphine or buprenorphine-naloxone, unless they:

• Have HIV
• Take certain medications that are not safe for breastfeeding
• Are actively using street drugs

Only small amounts of buprenorphine and naloxone get into the baby’s bloodstream. Additionally, breastfeeding can reduce NAS symptoms and duration.

Subutex vs Suboxone in pregnancy: side effects + dosing

Subutex and Suboxone have similar side effects because they both contain buprenorphine as the active ingredient.

Common side effects include:

• Nausea
• Constipation
• Drowsiness
• Headache

During your pregnancy, your provider may need to adjust your dose (often increasing it or splitting it into multiple doses per day) to keep you stable. 

‍Important note: Never adjust your dose or stop taking your medication without consulting your provider. If you’re running low on your prescription, contact your care team immediately.

Suboxone treatment with Ophelia

Ophelia provides evidence-based treatment via telehealth for individuals managing opioid use disorder during pregnancy. Our clinicians have experience treating pregnant individuals and consider several factors when choosing a medication:

• Clinical needs
• Medication safety
• Personal goals

Treatment through Ophelia is 100% online and judgment-free. You’ll be matched with a dedicated care team who will provide ongoing monitoring and support throughout your entire treatment and postpartum period.

We accept most major insurance plans for buprenorphine-based medications, including Medicaid, Medicare, and many private plans.

[Check your insurance coverage: https://my.ophelia.com/insurance-coverage]

[Explore treatment: https://my.ophelia.com/welcome]

Frequently asked questions

Is it safe to start buprenorphine treatment for the first time during pregnancy?

Yes. Many experts recommend buprenorphine to increase the chances of a healthy pregnancy for individuals managing opioid use disorder. Additionally, medication-assisted treatment is recommended over supervised withdrawal because it leads to better outcomes and a reduced risk of relapse.

Is it safe to take Suboxone during the first trimester?

Current evidence does not show increased risk when Suboxone is taken as prescribed during any part of pregnancy. However, some providers may prefer buprenorphine-only during early pregnancy. Either medication choice is clinically acceptable.

Can I switch from Suboxone to buprenorphine-only while pregnant?

Yes. If you or your provider feels more comfortable removing the naloxone component, your care team can help you transition to buprenorphine-only.

What happens if I run out of medication during pregnancy?

Contact your provider immediately so you can restart your dose as quickly as possible. Do not wait. Withdrawal can increase risks for both you and your baby.

Will my child have long-term developmental issues because of my medication?

There is no strong evidence linking buprenorphine treatment to long-term developmental harm. Findings suggest that prenatal opioid agonist exposure is not detrimental to normal physical and mental development. However, untreated OUD carries a significant risk.

Is the dose adjusted as pregnancy progresses?

You may need an increase in total daily buprenorphine as pregnancy progresses, which may include split dosing (e.g., 2–3 times daily dosing). However, your treatment should be tailored to your individual needs.

Can stress or illness affect how these medications work during pregnancy?

Stress and illness can lower your tolerance for discomfort, making it feel like your medication isn't working as well. They can also affect how your medication works indirectly if they lead to missed doses or substance use. However, evidence does not show that ordinary stress or illness reliably changes how buprenorphine or buprenorphine-naloxone works in pregnancy.

If you’re struggling, be sure to talk to your care team so they can provide support or adjust your treatment plan.

Can taking buprenorphine during pregnancy affect custody or involve child protective services?

You and your baby may be tested for drugs and alcohol at delivery, which could include methadone and buprenorphine. In some cases, positive drug tests may require a social worker or child protection agency to speak with you or assess your home environment—even if due to prescribed buprenorphine.

But keep in mind that being in treatment and following your care plan are viewed as positive steps. They show that you’re actively managing your health and pregnancy with medical support.

Policies vary by state, so it’s a good idea to talk with your providers ahead of time about what to expect. Having a clear plan in place can help you feel more prepared and avoid surprises after delivery.

What should I expect at the hospital during delivery if I’m on buprenorphine?

Continue your buprenorphine as advised by your clinician. Buprenorphine can support pain control, and hospital staff may provide additional pain management options if needed.

Tell your labor and delivery team about all drugs you’re taking to ensure they don’t give you labor pain medication that could cause withdrawal. Be honest with your delivery team so they can provide the best care for you and your baby.

ASAM also recommends that you:

• Meet with your anesthesiologist to discuss labor and delivery pain management
• If you’re having a C-section, discuss postoperative pain with your hospital team
• Continue counseling and use parenting support programs after giving birth
• Don’t stop your opioid medication too quickly or too soon, and only do so under supervision from a healthcare provider