Buprenorphine/Naloxone Safe for Opioid Addiction During Pregnancy

Pregnancies exposed to a combination of buprenorphine and naloxone show similar or even better neonatal and maternal outcomes compared to those exposed to buprenorphine alone, a recent study has revealed. The research, conducted by Dr. Loreen Straub from Brigham and Women's Hospital and Harvard Medical School, was published online on August 12, 2024, in the Journal of the American Medical Association.

The study aimed to compare perinatal outcomes between prenatal exposures to buprenorphine with naloxone versus buprenorphine alone. Researchers utilized healthcare utilization data from Medicaid-insured beneficiaries to conduct the population-based cohort study. The participants included 3,369 pregnant individuals who were exposed to buprenorphine combined with naloxone during their first trimester and 5,326 pregnant individuals who were exposed to buprenorphine alone.

Key findings from the study demonstrate that the combination of buprenorphine and naloxone significantly reduces the risks associated with neonatal abstinence syndrome, neonatal intensive care unit admissions, and infants being small for their gestational age. The weighted relative risks for these conditions were 0.77, 0.91, and 0.86 respectively. Furthermore, the study reported that the risks for maternal morbidity were not significantly different between the two groups, with comparative rates of 2.6 percent for the combination therapy group and 2.9 percent for the buprenorphine alone group.

The research did not find notable differences between the two groups in terms of major congenital malformations, low birth weight, preterm birth, respiratory symptoms, or the likelihood of cesarean delivery. These results remained consistent across various sensitivity analyses.

The authors of the study highlighted that these findings support the use of both formulations as viable options for treating opioid use disorder during pregnancy. This provides healthcare providers with the flexibility needed for collaborative treatment decision-making tailored to individual patient needs.

The study's conclusion suggests that both buprenorphine formulations—whether combined with naloxone or used alone—are effective and safe for managing opioid use disorder in pregnant individuals. This offers reassurance to both healthcare professionals and patients that either treatment option can be chosen without compromising on safety or efficacy.

Several authors involved in the study disclosed relationships with the pharmaceutical industry.