Opioid Withdrawal During Pregnancy

Key Takeaways

• Opioid withdrawal during pregnancy is medically dangerous and can cause preterm labor, miscarriage, and fetal distress.
• The American College of Obstetricians and Gynecologists (ACOG) and SAMHSA both recommend medication-assisted treatment (MAT) during pregnancy rather than detox or abstinence-based approaches.
• Methadone (Dolophine/Methadose) and buprenorphine (Suboxone/Sublocade) are both considered safe during pregnancy and are the standard of care.
• Neonatal abstinence syndrome (NAS) can occur in newborns exposed to opioids in utero but is treatable and produces better outcomes than untreated maternal opioid use.
• New Jersey does not criminalize substance use during pregnancy and offers specialized treatment programs for pregnant individuals.

Pregnancy complicates opioid use disorder management in ways that run counter to common assumptions. The instinct — shared by many patients, families, and even some healthcare providers — that a pregnant person should stop taking all substances immediately is understandable but clinically dangerous when it comes to opioid dependence. Abrupt opioid withdrawal during pregnancy carries risks to both the mother and the developing fetus that are well-documented in obstetric and addiction medicine literature.

This page explains why withdrawal during pregnancy is hazardous, what the evidence-based alternatives are, and where pregnant individuals in New Jersey can access appropriate care.

Why Opioid Withdrawal Is Dangerous During Pregnancy

Risks to the Mother

Opioid withdrawal in a non-pregnant individual is intensely uncomfortable but rarely life-threatening. During pregnancy, the physiological stress of withdrawal creates additional risks:

• Sympathetic nervous system activation — the surge of norepinephrine that drives withdrawal symptoms also affects uterine blood flow and contractility
• Dehydration — vomiting and diarrhea during withdrawal can cause dehydration that compromises both maternal health and placental function
• Cardiovascular stress — elevated heart rate and blood pressure place additional demands on a cardiovascular system already adapted to support pregnancy
• Nutritional disruption — inability to eat during withdrawal deprives both mother and fetus of essential nutrients during a critical developmental period
• Psychological distress — the anxiety, insomnia, and agitation of withdrawal compound the psychological burden of managing substance use disorder during pregnancy

Risks to the Fetus

The fetal risks of withdrawal are the primary reason that major medical organizations recommend MAT over detox during pregnancy:

• Preterm labor and delivery — the stress hormones and uterine contractility associated with withdrawal increase the risk of premature birth
• Spontaneous abortion (miscarriage) — particularly in the first trimester, when abrupt withdrawal can trigger pregnancy loss
• Fetal distress — reduced blood flow to the placenta during withdrawal episodes can compromise fetal oxygenation
• Stillbirth — in severe cases, particularly with repeated withdrawal episodes
• Intrauterine growth restriction — chronic stress and nutritional deficiency can impair fetal development

ACOG’s Committee Opinion states that medically supervised withdrawal during pregnancy should only be attempted when the patient fully understands the risks, desires it after counseling, and when appropriate clinical resources are available — and even then, the recommendation remains for MAT as the preferred approach.

Medication-Assisted Treatment in Pregnancy

Methadone During Pregnancy

Methadone (Dolophine/Methadose) has been used for opioid use disorder treatment during pregnancy since the 1970s, making it the longest-studied option. Key considerations include:

• Established safety profile: Decades of research support methadone’s relative safety during pregnancy when administered under medical supervision
• Dosing adjustments: Pregnancy alters methadone metabolism — increased blood volume, enhanced renal clearance, and changes in plasma protein binding often require dose increases during the second and third trimesters
• Split dosing: Some programs use twice-daily dosing in the third trimester to maintain more stable blood levels as metabolism accelerates
• Dispensing requirements: Methadone for opioid use disorder must be dispensed through a licensed Opioid Treatment Program (OTP), which can require daily in-person visits initially — a logistical challenge that prenatal programs often help navigate

Buprenorphine During Pregnancy

Buprenorphine has become an increasingly common alternative to methadone for pregnant individuals. Research supports its safety and effectiveness:

• Comparable maternal outcomes: Studies comparing buprenorphine and methadone in pregnancy show similar treatment retention rates and maternal health outcomes
• Potentially less severe NAS: The MOTHER (Maternal Opioid Treatment: Human Experimental Research) study, a landmark multicenter randomized trial, found that newborns exposed to buprenorphine required less medication for NAS treatment, had shorter hospital stays, and shorter treatment durations compared to those exposed to methadone
• Office-based prescribing: Unlike methadone, buprenorphine (Suboxone/Sublocade) can be prescribed by physicians in office-based settings, reducing the logistical burden of daily clinic visits
• Naloxone considerations: The sublingual film formulation Suboxone contains naloxone (Narcan) as an abuse deterrent. While earlier practice preferred buprenorphine monotherapy (Subutex) during pregnancy to avoid theoretical fetal naloxone exposure, current evidence suggests that the combination product has minimal additional risk because naloxone has extremely low sublingual bioavailability

The choice between methadone and buprenorphine during pregnancy should be individualized based on the patient’s substance use history, prior treatment experience, preference, and available resources. Both are appropriate first-line options.

Neonatal Abstinence Syndrome (NAS)

What NAS Is and How It Presents

Neonatal abstinence syndrome (NAS) occurs when a newborn who was exposed to opioids in utero experiences withdrawal after delivery. NAS can occur whether the mother was using illicit opioids or was maintained on MAT — the key difference is that MAT-exposed infants generally have less severe presentations and better overall outcomes.

Opioid dependence in the clinical context refers to the physiological adaptation that occurs with regular opioid exposure. It is distinct from opioid use disorder, which involves behavioral patterns of problematic use. A fetus exposed to opioids in utero develops physiological dependence as a predictable pharmacological consequence, not because of any behavioral component.

NAS symptoms typically appear within 24 to 72 hours of birth (though timing varies with the specific opioid) and can include:

• High-pitched, excessive crying
• Tremors and jitteriness
• Increased muscle tone
• Poor feeding and sucking difficulties
• Sneezing, yawning, and nasal stuffiness
• Sleep disturbances
• GI distress including loose stools

NAS is assessed using standardized scoring tools, most commonly the modified Finnegan Neonatal Abstinence Scoring System.

Treatment of NAS in Newborns

Most NAS cases are mild to moderate and respond to non-pharmacological interventions:

• Swaddling and skin-to-skin contact
• Low-stimulation environment — dim lighting, reduced noise
• Small, frequent feedings — breastfeeding is encouraged when the mother is stable on MAT and not using illicit substances
• Rooming-in — keeping the infant with the mother rather than in a neonatal intensive care unit has been shown to reduce NAS severity and shorten hospital stays

When symptoms are severe enough to require pharmacological treatment, morphine or methadone are the standard medications, administered in tapering doses over days to weeks.

Critically, NAS — while requiring monitoring and sometimes treatment — has no known long-term developmental consequences when appropriately managed. The outcomes for infants born to mothers in stable MAT programs are substantially better than those born to mothers with untreated opioid use disorder, where risks of prematurity, low birth weight, NICU admission, and maternal overdose are all significantly elevated.

Prenatal Addiction Treatment in New Jersey

NJ Programs for Pregnant Women

New Jersey has several initiatives and resources specifically for pregnant individuals with substance use disorders:

• NJ Substance Abuse Treatment Hotline (1-844-276-2777): Provides referrals to programs that serve pregnant women, including those with immediate openings
• NJ DMHAS-licensed programs: The Division of Mental Health and Addiction Services licenses treatment programs throughout the state, many of which have specialized tracks for pregnant and postpartum individuals
• Federally Qualified Health Centers (FQHCs): Many NJ FQHCs offer integrated prenatal care and substance use disorder treatment, including buprenorphine prescribing
• NJ Medicaid: Covers both MAT and prenatal care for eligible individuals, and NJ provides presumptive Medicaid eligibility for pregnant women, meaning coverage can begin immediately while the full application is processed
• OTP programs: New Jersey’s Opioid Treatment Programs can accommodate pregnant patients for methadone maintenance, with many offering priority enrollment

Legal Protections and Stigma Reduction

Stigma remains one of the most significant barriers to treatment for pregnant individuals with opioid use disorder. Fear of legal consequences, child welfare involvement, or judgment from healthcare providers prevents many from seeking the care that improves outcomes for both mother and infant.

Important legal context for New Jersey:

• New Jersey does not criminalize substance use during pregnancy. Unlike some states that have prosecuted pregnant individuals for drug use, NJ treats substance use disorder as a health condition rather than a criminal matter in the prenatal context.
• NJ DYFS (now DCF) involvement: While the New Jersey Division of Child Protection and Permanency (CP&P, formerly DYFS) may be notified when a newborn tests positive for substances, participation in treatment is a protective factor. Mothers actively engaged in MAT programs are generally not subject to child removal based solely on their substance use disorder.
• HIPAA protections and 42 CFR Part 2: Federal confidentiality regulations provide enhanced privacy protections for substance use disorder treatment records, preventing disclosure without patient consent in most circumstances.

Healthcare providers in New Jersey are encouraged to screen for substance use during pregnancy using validated tools and to respond with treatment referrals rather than punitive measures. ACOG has specifically advocated against policies that deter individuals from seeking prenatal care and substance use treatment.

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This article is part of our complete guide to opioid addiction in New Jersey. For information on withdrawal management medications, see opioid withdrawal medications and treatment. For details on buprenorphine treatment specifically, visit Suboxone treatment: how it works.

For information on MAT programs, see our guide to medication-assisted treatment. For NJ Medicaid coverage details, visit our page on NJ Medicaid and rehab.