Subutex

[RJ_Jordan]

Any advice? I have been on subutex for a month and have been hearing horrible things that your newborn will go through shortly after delivery.. My doctor assured me it was COMPLETELY safe and I put my trust in him.. I asked him to tapere off and he says that its not a good idea. I'm only 8 weeks and I was wondering if you could give me any advice on how to taper my self off??? Also is the fetus getting the medication already? My dose is 8mg twice daily, I would like to be at 2mg or none at all.

[Julia M Aharonov, DO]

Dear Jordan,
Gentle tapering has not been shown to cause miscarriage or any other damage to the baby while pregnant, especially when done under physician's guidance. Make sure your OB is involved in this process and is checking in on the baby's progress. It is very important for you both to be clean at the time of delivery so that you can have healthy and meaningful bonding, you can nurse safely and start your new life as a mother in a beautiful and committed way.

[RJ_Jordan]

I was referring to you saying it seems though I was asking for your permission? Is the baby feeling the same discomfort I am?? Also I saw a post where you said you can safely taper in 5 days, is that also with pregnancy? My biggest concern is that this whole mess with subutec will cause a miscarriage.

[Julia M Aharonov, DO]

Gentle tapering will not be harmful to the baby, but it should be done under OB's supervision.
P.S. I apologies if my advice sounded like permission.

[RJ_Jordan]

Thanks for the comment! I haven't seen my OB yet! It took 2 weeks to get an appointment, I go Thursday. First of all I don't think I was looking for permission, just advice. Everyone has a different experience with pregnancy so no one knows if my baby can be safety delieverd on subutex. Of course when I see my doctor we will discuss this issue but also she isn't the one who would prescribe it. I wasnt put on subutex for addiction to pain killers, have never even taken them except after the delivery of my first child. All I was looking for in writing you was advice on tapering not an ok to take it or telling my its safe.. My thoughts are I don't won't to be on it period but have experienced discomfort the past few days from going to 16mg to 8 mg, not badly but enough to notice.. I'm hoping that if its not affecting me that bad hopefully its okay for the baby.. I just haven't been on it that long and don't know enough about it.

[Julia M Aharonov, DO]

Dear Jordan,
It would be best for both you and the baby to be gently tapered off of Subutex while you are still pregnant, so that you are both drug free by the time of the delivery and your baby will not need to go through any withdrawals at all.  Even though babies have been safely delivered to mothers taking Subutex and nursed by those mothers while on Subutex, I still strongly believe, that it would be better for both of you to be drug free at the time of delivery.  
I understand that you may have some discomfort while tapering the Subutex, I you do have to do it gently. The last taper should be titrated slowly, down to 0.5mg/day, then 0.25mg and if you are still uncomfortable stopping there, half of that.
It sounds to me, though, that you are looking for a permission from me to continue taking the Subutex. As I said before, it is possible to have a baby while doing that, but you are on a very high dose of Subutex and there is a likelihood that baby may experience withdrawals, especially if you do not breastfeed.  
Withdrawals from Subutex are very unpleasant and may keep the baby in the NICU and away from your loving arms for many days.
I suggest that you read my blog on pregnancy and addiction that talks more about it. Click on my name in blue and than "blogs".  
Good luck to you and make sure you discuss all of this with your OB. They must be in the loop on all your medical care. Good luck to both of you.