Opioid use during pregnancy can be challenging and affects women from all walks of life, ethnic groups, and socioeconomic classes. Women that misuse prescription opioids and/or heroin during pregnancy often have other co-existing mental health problems, and a history of depression, anxiety or trauma. They are more likely to participate in high risk behaviors, use other substances such as tobacco, marijuana, and cocaine, and often have late or poor prenatal care.  Medically supervised withdrawal without medication is not recommended during pregnancy as this typically leads to relapse and poor pregnancy outcomes, including miscarriage. 
Methadone and buprenorphine are two medications that are safe to use during pregnancy to prevent opioid withdrawal symptoms, decrease cravings, and help prevent relapse. Methadone has traditionally been used to treat opioid use disorder in pregnancy, but buprenorphine has been shown to be a safe and effective alternative. Buprenorphine has fewer drug interactions, can be given on an outpatient basis, and less dosing adjustments are typically needed. Neonatal abstinence syndrome (NAS) is an infant withdrawal syndrome and is usually less severe when taking buprenorphine. Breastfeeding is encouraged, as long as there are not other contraindications. Psychosocial treatment or counseling with an addiction specialist is an integral part of medication assisted treatment and can help to prevent relapse.
- Jones, HE, Heil, SH, O’Grady, KE, Martin, PR, Kaltenbach, K, Coyle, MG, et al., Smoking in pregnancy women screened for an opioid agonist medication study compared to related pregnant and non-pregnant patient samples. Am J Drug Alcohol Abuse 2009; 35:375-80.
- Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017; 130:e81-94.