Quitting Suboxone (recently switched to subutex) Cold Turkey- Physical danger??

[Mafioso]

we have more data on methadone in pregnancy than buprenorphine

That is my guess too, thanks for the link.

 

[MotherJupiter]

That is my guess too, thanks for the link.

I thought about all this too but fron everything i read, a mother who uses Bupe throughout uer pregnancy, the baby has like a 22-30 something percent chance of being born with WD symptoms and that's the lowest i read out of all opiate and maitnence meds.

I will say with my previous child after the 1st trimester when i was released from probation i dabbled here and there in low dose hydros, occasional subutexes and pretty regularly tramadol. From 2nd trimester until a week before birth when i stopped.i was induced at 42 weeks, baby was born very happy healthy and calm and has exceeded all of her milestones. She is EXTREMELY SMART amd well mannored and i know all mothers belive their child is perfrct but i really think she turned out exeptional in every aspect. I know that dosent mean much concerning current pregnancy and bupe habit but im hoping if i get my doses down low enough baby will be born healthy and happy and we wont need to do the 10 day observation stay. Tell my husband is one thing, but explaining to family why we have to stay in hospital so long is a wholleee different story.

If its ok with MODs i can kinda journal my tapers and doses on this thread and update with info from my doctors.

 

[JessFR]

Everyone is talking about risks to the baby from WDing while pregnant, im wondering if the risks are just misscarrige or if there are other risks like birth defects and such. I know this is going to sound extremely awful and cold, but i feel like id rather risk loosing the pregancy while till in the very eairly non viable out side of the body stages than risk habing baby born dependant on this awful stuff.

I'm gonna cut you some slack cause Im sure this must be a very emotionally charged time right now.

OK so no, the risk isn't birth defects its miscarriage. But I really think you are greatly overestimating the implications of the baby being born opioid dependent.

The baby will never even know if you don't tell them when they get older. They won't remember it at all. Their life shouldn't be any different than if they'd been born not dependant.

Your baby will be totally fine being born opioid dependant. This isn't like alcohol or some other drugs. They won't be harmed in the long term at all. They won't know that they were born dependant (unless you tell them obviously), they won't be any worse off.

Also I don't know if this changes anything for you, but the risk isn't just to your baby. I mean the opioid withdrawal won't kill you, but a miscarriage can be medically dangerous to you in itself. Your health is at risk too.

I think you should talk to your doctor, explain all your concerns like you have here. And take it from there. Even if in the end you decide that you absolutely will not allow the baby to be born opioid dependant, there may still be much safer ways to do that than trying to get off it as fast as possible.

You still have quite a lot of time before the baby is due. Plenty in which to taper off slowly. Then the risk to you and the baby is minimized, and you won't have to explain to your family why the baby has to stay in hospital.

 

[totach]

Can Subutex harm your baby?
Currently, Subutex is in the middle, in the “C” category for use during pregnancy. Like with the other drugs in the “C” category, it is unknown whether buprenorphine can severely harm an unborn baby as there are no well-controlled studies in humans that prove the risks of taking Subutex while pregnant.

I believe the baby stayed in the hospital a bit longer then usual but I don't think he went thru the whole process of when a baby is born fully addicted. definetly switch to Subutex which I see you already did. Now you can either taper off if youd like or stay on the whole time. just don't cold turkey that's the worst thing you can do.

 

[MotherJupiter]

Thank you guys, ive taken about 25% of my normal dailey dose today and am alright! Nit fantastic but am able to go shopping and play activly with my toddler. I thinka slow taper from here is very doable and hopefully my ob understands and can help ( f not ill find one who does) hopefully my husband will be able to see past his initial shock and anger and understand i really mean the best i can for our family. Thank you all again soo much for such support. ?

 

[JessFR]

Can Subutex harm your baby?
Currently, Subutex is in the middle, in the “C” category for use during pregnancy. Like with the other drugs in the “C” category, it is unknown whether buprenorphine can severely harm an unborn baby as there are no well-controlled studies in humans that prove the risks of taking Subutex while pregnant.

I believe the baby stayed in the hospital a bit longer then usual but I don't think he went thru the whole process of when a baby is born fully addicted. definetly switch to Subutex which I see you already did. Now you can either taper off if youd like or stay on the whole time. just don't cold turkey that's the worst thing you can do.

Yeah I was going to mention something about this but I got kinda distracted. As I seem to recall naloxone is a bit more unknown regarding pregnancy safety than buprenorphine. They might both be fine but if you can use buprenorphine alone without naloxone that would be safer.

Also I agree big time. It's the withdrawal more than anything that poses the danger here. While it would be safest not to try and taper off at all, if you must taper off, if you do it very slowly over the next several months it will probably be OK.

Thank you guys, ive taken about 25% of my normal dailey dose today and am alright! Nit fantastic but am able to go shopping and play activly with my toddler. I thinka slow taper from here is very doable and hopefully my ob understands and can help ( f not ill find one who does) hopefully my husband will be able to see past his initial shock and anger and understand i really mean the best i can for our family. Thank you all again soo much for such support. ?

I really recommend that if you're going to taper off, that you do it as slowly as possible over the next few months. If you feel like you're in serious withdrawal, I beg you not to risk you and your babies health and take a bit more subutex until you feel a bit better. So long as you don't go into bad withdrawal you and your baby will probably be OK.

I'm sure this must be stressful for you, so if anything ive said has added to your worries at all I want you to know I'm sorry for that. I'm just concerned for you.

 

[VastEmpty]

MotherJ -

I agree with what Jess said entirely. You need to take your concerns to a doctor and go over them in detail - it’s scarier not knowing the answers to these questions than it is being educated on this by a health care professional.

You have time to tell your husband. Do go to the doctors appointment yourself, if you can. You will need some private time with your doctor. You won’t be able to properly plan or assess your options until you have proper answers to some of these questions.

With regard to birth defects, there is very, very little medical evidence that I could find that would support there being a correlation between the two (opiate use while pregnant and birth defects). But again, ASK YOUR DOCTOR. We could tell you all day that it’ll be fine but we aren’t doctors, we are just here to support you and help you the best we can.

One more thought - you seem to be very concerned to have family question why your baby may need to stay in the hospital after birth for longer than expected. I would really encourage you to see a therapist or councilor and talk about your family dynamics and this issue.

It may be possible that you will be forced to answer these questions because it is better for your baby. Please don’t feel that you have to rush getting off subs because of your family’s disapproval. That is their problem, not yours and certainly not the baby’s. I know that there is a lot of shame around addiction. You should find a professional to help you work through this. Time is on your side, in a lot of ways - but in a lot of other ways you kinda gotta get on it. I know it’s all overwhelming and scary, but you have the best motivation imaginable.

We are here to help and support you. The MODS don’t mind at all if you use your thread as a sort of tapering and support journal. That’s what we are here for.

- VE

 

[Mafioso]

If its ok with MODs i can kinda journal my tapers and doses on this thread and update with info from my doctors.

Definitely, that's partly what we are here for, just let us know if there is anything we can help you with.

 

[MotherJupiter]

Yeah I was going to mention something about this but I got kinda distracted. As I seem to recall naloxone is a bit more unknown regarding pregnancy safety than buprenorphine. They might both be fine but if you can use buprenorphine alone without naloxone that would be safer.

Also I agree big time. It's the withdrawal more than anything that poses the danger here. While it would be safest not to try and taper off at all, if you must taper off, if you do it very slowly over the next several months it will probably be OK.



I really recommend that if you're going to taper off, that you do it as slowly as possible over the next few months. If you feel like you're in serious withdrawal, I beg you not to risk you and your babies health and take a bit more subutex until you feel a bit better. So long as you don't go into bad withdrawal you and your baby will probably be OK.

I'm sure this must be stressful for you, so if anything ive said has added to your worries at all I want you to know I'm sorry for that. I'm just concerned for you.

I wasnt in SERIOUS withdrawl at all today on this dosing regimen for today actually id rate my top WD at like a 1 or 2, just mild discomfort. Most of my pain smd discomfort just came from pregnancy, sore hips and legs. When i WD hard i get EXCRUCIATING pain in my.lower bacl hips pelvis upper leg area like i got hit my steam roller its unbearable, today it was just the same level of soreness that i felt pregnant with my 1st before i got back on the opiates after being off of them for 2 years, so normal sober pain and not WD pain if that makes sense. The main reason i dosed as much as i did ( a total of about 9mgs) was due to not wanting to enter full WD and not because i was in full WD. I do pla. On doing a taper my body can handle, a minimal dose to avoid WD without chasing a full euphoric buzz.

 

[MotherJupiter]

MotherJ -

I agree with what Jess said entirely. You need to take your concerns to a doctor and go over them in detail - it’s scarier not knowing the answers to these questions than it is being educated on this by a health care professional.

You have time to tell your husband. Do go to the doctors appointment yourself, if you can. You will need some private time with your doctor. You won’t be able to properly plan or assess your options until you have proper answers to some of these questions.

With regard to birth defects, there is very, very little medical evidence that I could find that would support there being a correlation between the two (opiate use while pregnant and birth defects). But again, ASK YOUR DOCTOR. We could tell you all day that it’ll be fine but we aren’t doctors, we are just here to support you and help you the best we can.

One more thought - you seem to be very concerned to have family question why your baby may need to stay in the hospital after birth for longer than expected. I would really encourage you to see a therapist or councilor and talk about your family dynamics and this issue.

It may be possible that you will be forced to answer these questions because it is better for your baby. Please don’t feel that you have to rush getting off subs because of your family’s disapproval. That is their problem, not yours and certainly not the baby’s. I know that there is a lot of shame around addiction. You should find a professional to help you work through this. Time is on your side, in a lot of ways - but in a lot of other ways you kinda gotta get on it. I know it’s all overwhelming and scary, but you have the best motivation imaginable.

We are here to help and support you. The MODS don’t mind at all if you use your thread as a sort of tapering and support journal. That’s what we are here for.

- VE

Thank you so much for all of this insight, you habe given me a strong sense of warmth and made me feel much more comfortable with this all. Everyone has helped but i can feel a virtual hand holding from you haha, i dont know anything about you, weather you are a woman or have gone through this too (you may have mentioned but ive read alot of posts and dont remeber who said who) but i am really feeling not so alone anymore. ?

 

[MotherJupiter]

Definitely, that's partly what we are here for, just let us know if there is anything we can help you with.

Thank you guys soooo much, really its helping put me ay ease and giving me a great support system so far. Im glad I seem to have posted this thread in the correct spot

 

[Mafioso]

I'm gonna cut you some slack cause Im sure this must be a very emotionally charged time right now.

OK so no, the risk isn't birth defects its miscarriage. But I really think you are greatly overestimating the implications of the baby being born opioid dependent.

I think you should be a little more cautious when making statements like this, as the literature seems to contradict your statements. Birth defects and miscarriage are both potential concerns, as well as neonatal abstinence syndrome. This is what the literature that I have found says, if you have contradicting literature I would like to see it. It's a complex issue, and due to the impact it can have on peoples' lives, it is difficult to study as well.

"This article summarizes the available literature documenting potential harms associated with prescription opioid use during pregnancy, including poor fetal growth, preterm birth, birth defects, and neonatal abstinence syndrome."

Prenatal Exposures and Short and Long Term Developmental Outcomes: Prescription Opioids in Pregnancy and Birth Outcomes: A Review of the Literature

Prescription opioids are used prenatally for the management of pain, as well as for opiate dependency. Opioids are known to cross the placenta and despite the evidence of possible adverse effects on fetal development, studies have consistently shown prescription ...

www.ncbi.nlm.nih.gov

EDIT:
From the link above:
"In this review, we summarize the available literature on opioid use in pregnancy and birth outcomes. The limited studies that have assessed head circumference and birth length, have found no association with opioid use. These markers of fetal growth have been well studied in the context of dependency and for BMT-exposed neonates, both head circumference and birth length fall within normal ranges, further demonstrating that opioid medications may not affect fetal growth. On the other hand, results for birth weight and preterm birth have been inconclusive and further studies are needed to assess if opioids pose a risk for preterm birth or LBW. There is a growing body of evidence to suggest that opioids may be associated with specific birth defects. To date, five studies have identified an association with CHDs and three studies have found elevated estimates with NTDs and clubfoot."
Emphasis is mine. This is taken from the conclusion of the artile, which is a review of the available literature as of June 2015.

Jess is correct in that the major concerns will be miscarriage from withdrawal or neonatal abstinence syndrome(NAS), but there is possibility of other complications. This is why it's so essential that you talk to a doctor who well versed in this subject, and can work with you on making an informed decision. A decision that you might want to include that father in, if you intend for him to be part of the child's life.

MotherJ, I understand it's probably very difficult for you to even think about talking to your husband about, but given all the possible problems.. I don't think it is a very smart thing to be trying to taper off buprenorphine without at least letting someone know who can get help. I don't want to cause unnecessary alarm, but I also can't advise about what is safe and what isn't for you and your child, so I have to suggest that you seek someone who does.

 

[JessFR]

I don't believe I am contradicting the literature. I've seen no evidence of any risk of birth defects resulting from opioid use or discontinuation. I've also seen little evidence of a direct risk of miscarriage related to stable opioid use in pregnancy. But it's widely recognized that opioid withdrawal carries a risk of miscarriage. There is neonatal abstinence syndrome yes, but it's treatable and much less dangerous than the risk of miscarriage from withdrawal.

I checked your link but was unable to find direct data of birth defects relating to opioid use in pregnancy. Given how many pregnancies have involved exposure to opioids, if there were such risks I would think they'd be much more well known.

If you have data suggesting opioid substitution therapy in pregnancy carries risk of birth defects or miscarriages then I'd be happy to read it. But currently I'm not aware of any.

Regardless, this is why I strongly recommended talking to their doctor. Because even if I'm completely correct, it would mean more coming from their doctor. And if I'm wrong or what I said isn't the whole story, that's the opportunity for it to be corrected.

This thread may not be the appropriate place for this discussion. I'm happy to talk to you about your concerns in private message, I'm just concerned about possibly derailing this thread or providing confusing or misleading informatiom before the truth is entirely established. It's up to you I'm just a little concerned about continuing this discussion here.

 

[Mafioso]

Here are a couple videos I found while trying to learn more about the subject. Depending on your area, there may be resources available. I would suggest maybe calling social workers and rehabs in your area to see if you can get a lead on any locally available special services.

 

[Mafioso]

I don't believe I am contradicting the literature. I've seen no evidence of any risk of birth defects resulting from opioid use or discontinuation. I've also seen little evidence of a direct risk of miscarriage related to stable opioid use in pregnancy. But it's widely recognized that opioid withdrawal carries a risk of miscarriage. There is neonatal abstinence syndrome yes, but it's treatable and much less dangerous than the risk of miscarriage from withdrawal.

I checked your link but was unable to find direct data of birth defects relating to opioid use in pregnancy. Given how many pregnancies have involved exposure to opioids, if there were such risks I would think they'd be much more well known.

If you have data suggesting opioid substitution therapy in pregnancy carries risk of birth defects or miscarriages then I'd be happy to read it. But currently I'm not aware of any.

Read the conclusion of the link I provided. I updated the post as well to include the quote that states the risks. As to why there may not be clear definitive studies, if you read the next paragraph in the conclusion of the study I posted you will understand why:
"Studying opioid use in pregnancy presents multiple methodological challenges. Studies are vulnerable to confounding by indication, as women who take opioids—or who take a particular opioid versus another—may be different from women who do not. Additionally, it can be difficult to differentiate whether the underlying condition for opioid use (e.g., migraine) or the medication itself is responsible for any observed elevated risk. Future studies should consider the nature and severity of the underlying condition and address the potential for confounding by indication. Due to small numbers, studies often consider opioid medications as a homogeneous group and by doing so any effect for specific medications may be missed. As it is unlikely that all medications within the class of opioid medications have the same mechanism of action on the fetus, we recommend future studies assess individual opioid medications. Larger studies are needed, especially to allow for assessment of individual opioids. Furthermore, studies should focus on precise exposure measurements, with dose and duration information and accurate outcome ascertainment."

Further more, a lack of evidence does not support or favor any claim, for or against. The one making the claim is the one responsible for providing the evidence, which I feel that I did. There is inconclusive evidence showing there is risk of complications and defects, suggesting that caution should be taken and more studies should be done. I have yet to see any evidence in support of your claim, that the only risk is NAS or miscarriage.

 

[totach]

I know tapering isn't ideal but in the last 15 years ive bin on this site(I had a different user name before) this situation/topic has come up multiple times. Most of the women switched to Subutex and even methadone and I don't believe any of the women had an issue when the baby was born. There has also bin ones with the woman getting freaked out by the pregnancy and decided to taper and again both way worked . So don't stress do what is comfortable for you and in return it will be more comfortable for the baby. Keep your spirits up!


Point is they don't know it can go either way. like I just stated luckily all the threads thru the years no matter which choice they made the baby was fine .

 

[JessFR]

Read the conclusion of the link I provided. I updated the post as well to include the quote that states the risks. As to why there may not be clear definitive studies, if you read the next paragraph in the conclusion of the study I posted you will understand why:
"Studying opioid use in pregnancy presents multiple methodological challenges. Studies are vulnerable to confounding by indication, as women who take opioids—or who take a particular opioid versus another—may be different from women who do not. Additionally, it can be difficult to differentiate whether the underlying condition for opioid use (e.g., migraine) or the medication itself is responsible for any observed elevated risk. Future studies should consider the nature and severity of the underlying condition and address the potential for confounding by indication. Due to small numbers, studies often consider opioid medications as a homogeneous group and by doing so any effect for specific medications may be missed. As it is unlikely that all medications within the class of opioid medications have the same mechanism of action on the fetus, we recommend future studies assess individual opioid medications. Larger studies are needed, especially to allow for assessment of individual opioids. Furthermore, studies should focus on precise exposure measurements, with dose and duration information and accurate outcome ascertainment."

Further more, a lack of evidence does not support or favor any claim, for or against. The one making the claim is the one responsible for providing the evidence, which I feel that I did. There is inconclusive evidence showing there is risk of complications and defects, suggesting that caution should be taken and more studies should be done. I have yet to see any evidence in support of your claim, that the only risk is NAS or miscarriage.

A lack of evidence does support a claim when that lack of evidence is in spite of repeated study which should have produced evidence were the problem real. You can't prove a negative. You can't prove that opioids definitively do not cause birth defects. You can only show that studies have failed to show any evidence of such risks and that statistically if there were an association then the study should have demonstraighted it.

I'm not clear on what exactly it is that you're arguing here. Are you arguing that opioid withdrawal in pregnancy is not dangerous? That opioid use in pregnancy can cause defects or miscarriage? Are you simply arguing that how I expressed my concerns weren't sufficiently supported by evidence? I'm not trying to attack you here, I legitimately am not sure what you're trying to argue here.

What I am arguing is that current medical practice is to not undertake withdrawal during pregnancy. On the face of it that makes sense. Withdrawal is quite stressful for the body, and that's not something you want to have happen during a pregnancy. The only time you'd want to do that is if the alternative were even more dangerous. And pregnant women are frequently prescribed opioids. Many pregnancies have spent all 9 months on opioids like methadone, and studies have not shown that there's any long term negative effects of being born opioid dependant.

Honestly, something I find truly disgusting and deplorable is how judgemental society is against pregnant drug users. It's not about their health or the health of their baby. It's about people feeling morally superior by condemning other people. And in doing so they themselves engage in more harm than the mother they're casting judgement on.

So many pregnant women feel so guilty over continuing to use opioids while pregnant. But they shouldn't. Continuing to use opioids, provided it's in the form of substitution therapy, is the standard treatment in medicine for opioid dependant mothers. They shouldn't have to feel judged and pressured into making decisions that could harm them or their babies health because of the ignorant prejudice and judgement of greater society, their family members and friends, etc.

I find it outrageous that women feel pressured to put themselves and their babies through withdrawal when there are better opinions because of a stigma against drug use while pregnant. Pregnant opioid users need support, not judgement. Even the way it's described. People saying the "babies are born addicted" is complete crap. I would argue that nobody is born addicted. They are born dependant. That might seem like splitting hairs, but I think there's a subtle and important difference. Addiction is a mental process, it carries with it connotations of the kind of things people say and do due to addiction. And addiction means you are forever at risk of the addiction becoming active again. Whereas dependence is purely medical. And a baby born dependant has a purely medical issue. There's no psychological component. It's little different to being dependant on many other non recreational medicines and doesn't warrant the stigma of the addiction label. These babies aren't addicts.

I understand you're not making such judgements yourself, this isn't directed towards you. But I watched the videos you put up. And the first one made me feel a sense of outrage for how pregnant women are judged by people who have no business judging anyone.

 

[Mafioso]

A lack of evidence does support a claim when that lack of evidence is in spite of repeated study which should have produced evidence were the problem real.

This is false. As stated, a lack of evidence can not support anything, beyond not knowing, that is. The burden of evidence remains on whomever is making the claim, even if that claim is that there is no evidence. So in this instance, if someone is making a claim that there is no evidence showing that using opioids while pregnant will lead to birth defects, the evidence required would be studies showing no variations beyond the average in children of the mothers who used during pregnancy. Or, more realistically, at what levels can what opioids be used without a noticeable or significant increase in risk.

Those studies don't exist, that I am aware. In fact, as pointed out in the cohort study I posted, there are some that suggest the contrary.

You can't prove a negative.

This is itself a negative, so if it were true, you wouldn't be able to prove it. Ignoring that, it's demonstrably false. For instance, if I were to claim that there is no water in the bucket, there are a number of ways we can verify this. We can physically look to see if there is water, we can feel with our hands, we can listen for water, we can use tools like scales to weigh the bucket and calculations to figure if there is enough weight to account for water or not. (more on that here:https://en.wikipedia.org/wiki/Proving_a_negative)

But I agree, we are definitely getting off topic, and as many have pointed out, our opinions on the matter aren't all that relevant. If you want to further debate me, you can PM me, but you wont get very far there either without providing something to substantiate your claims. My intent wasn't to start a debate, but to diffuse misinformation, which you accuse me of spreading despite the fact that my claims aren't even truly mine, in fact just regurgitation of what professionals have said, and I have provided evidence to show this- while you on the other hand rely solely on your own words, reasoning, and opinions. I'm not sure if your outrage is targeted at me, but it is unjustified if so, and if that is indeed the truth, you need to take some time to review what I have said and presented.

 

[MotherJupiter]

I know tapering isn't ideal but in the last 15 years ive bin on this site(I had a different user name before) this situation/topic has come up multiple times. Most of the women switched to Subutex and even methadone and I don't believe any of the women had an issue when the baby was born. There has also bin ones with the woman getting freaked out by the pregnancy and decided to taper and again both way worked . So don't stress do what is comfortable for you and in return it will be more comfortable for the baby. Keep your spirits up!


Point is they don't know it can go either way. like I just stated luckily all the threads thru the years no matter which choice they made the baby was fine .

Thank you, that makes me feel a bit better. The thing that gets me the most in all of this, is given how long ive been on these stupid things (thank my awesoke neglectful doctor) im not even dependant on opiods, im dependant on these horrible things. I know they ARE an opiod but they are meant to be taken in substitution. Ive substituted soo long that now any other substance I have ever taken is forigne to me but my body apparently very much needs these to function.

Ive seen it happen in a close family memeber. On them for 9 years. Goes to the doctor every week. Never has a penny to her name as all money goes to her meds. But i naively thought it would be different with me. Shes weak, im strong. Ill be able to stop when i want to. But thats proving to be much more difficult than i thought.

 

[MotherJupiter]

18 hours since my last dose of 3mg, i have taken 4mgs as i feel the fluttering of WDs begging to set in. Hoping to not take anymore today tha. The 9mgs i took yesterday and by the end of the week be able to comfortably cut out a couple mgs without hitting WD

Considering this time last week i was taking 20mgs a day amd would habe already had 10 mgs in me and wanting more, i think im doing well. Im realizing the vast majority of my need for such a high dose came from mental wds, now that my mental state is wanting to cut back, its easier than i originally thought. Still keeping my body out of bad WDs