Sunday, 5 June 2011

Subutex vs Suboxone

I have in the past covered this topic of Subutex vs Suboxone during pregnancy but I think we need to go over it again. There have been only 21 published reports into Buprenorphine in pregnancy and those studies have involved the voluntary collection of information from expectant mother to be. Approximately 350 infants were observed in the studies.

One matter worth noting -- although Subutex and Suboxone are officially unreccommended during pregnancy, the initial observations have shown them to be not only safe but a better alternative than Methadone. Because Buprenorphine is such a new drug, there simply hasn't been enough time to accurately study the effects on the fetus.

Both Subutex and Suboxone are made from the same parent drug - Buprenorphine. The only difference is that Naloxone which is added to Suboxone in an effort to curb the blatant misuse of Subutex patients who were trying to inject it. Both Subutex and Suboxone are partial agonists which means that they work by coating the opiate receptors in the brain whilst stimulating it slightly at the same time.

Subutex and Suboxone are consumed sub-lingually meaning that the drug is absorbed into the bloodstream through the blood vessels under the tongue. When Subutex or Suboxone is swallowed it loses it's potency as the stomach acids break it down. Following this line of reasoning, many Doctors will now overlook the tiny amount of Buprenorphine that does make it's way into breast milk and unofficially support breastfeeding in lactating mothers on Subutex or Suboxone.

Most Doctors will switch a mother-to-be onto Subutex throughout pregnancy and breastfeeding because the Naloxone found in Suboxone has been linked to an increased chance of seizures in the baby once born.

Statistically, while as many as 95% of Methadone or Opiate babies will experience withdrawals known as  NAS -- Neonatal Abstinence Syndrome.

Compare that to around 60% of Subutex babies who experience NAS  or the 45% of babies who experience symptoms severe enough to require hospitalization and medicating. Treatment may involve environmental treatments such as

  • providing a low stimuli environment, 
  • swaddling,
  • lots of cuddles 
  • and tending to baby in a dark, temperate room
To more drastic measures that involve treating baby with very low volumes of Morphine. The dose is calculated by baby's birth weight and is administered four times per day. During this time baby is closely monitored in a special cares nursery for signs of cardio and/or respiratory distress.

The Finnegan Scoring System is implemented to monitor baby's comfort and progress - high scores may require the Paediatrician
 to increase the dose, low scores indicate that baby is ready to begin a slow process of weaning.

Given the choice, Subutex should always be preferred over Suboxone during pregnancy. 

Once again, I would like to invite mothers (or families) or healthcare providers to contact me in regards to a support network for families during this time of uncertainty. Leave your details below or contact me at eliz.nesbitt@gmail.com

Visit the

Some useful references include:
==> Finnegan Scoring Chart (print it out if you're expecting...congrat's btw)
==> Printable NAS Brochure - provided by King Edward Memorial Hospital (Maternal health hospital in Western Australia which is responsible for the gathering of much info)

My other posts on this matter can be found at:
==> Opiates in Pregnacy Subutax, Suboxone Methadone (This is a great one to start with...very detailed , lots of facts and info)


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