Subutex withdraw

SteveNNP, MSN, NP · Oct 13, 2008

What is Subutex?

I love my cat! · Oct 13, 2008

What is Subutex?

Subutex is the brand name for buprenorphine.

Buprenorphine is an opioid (narcotic) medication that is similar to morphine, codeine, and heroin.

Buprenorphine is used to treat narcotic addiction.

Buprenorphine should be used only by the person it was prescribed for. Buprenorphine should never be given to another person, especially someone who has a history of drug abuse or addiction. Buprenorphine can cause withdrawal effects in a person who is addicted to narcotics. Keep the medication in a secure place where others cannot get to it. FDA pregnancy category C. This medication may be harmful to an unborn baby. It could also cause addiction or withdrawal symptoms in a newborn if the mother takes buprenorphine during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Buprenorphine passes into breast milk and may be harmful to a nursing baby. It may also decrease breast milk production. Do not use buprenorphine if you are breast-feeding a baby. Do not give this medication to a child.

HR_LPN · Oct 13, 2008

I have had no experience with Subutex, but we have had some Methadone withdrawals. We give Morphine or Phenobarb.

Imafloat, BSN, RN · Oct 13, 2008

I've never heard of subutex either. We have had babies withdrawing from methadone and other things. We do abstinence scores with all assessments and if they score over a certain number consistently, they get methadone. We will use phenobarb too if it seems like the methadone isn't working.

I can't imagine not doing anything, the withdrawl babies are high maintenance, even when they are getting methadone. Do you have a special area in your nursery for them?

lvnurs9 · Oct 13, 2008

We always treated withdrawl babies.... otherwise they are in your unit longer then the months they are already there.... I think it's sad that some people believe in not treating them. They are miserable and not my cup of tea :)

LoveTheNICU · Oct 13, 2008

I am working on finishing my NNP, and one of my professors is very heavily involved in a study right now that is comparing the effects of buprenorphine and methadone. They have studied over 800 infants born to mothers whose addiction was either treated with methadone or Subutex throughout their pregnancies, with a focus on the severity and length of withdrawal symptoms in those babies. Their hypothesis is that the Subutex will less severe symptoms and shorter withdrawal periods after birth, and their preliminary research evidently supported this. However, since the study is double-blind, there is no way to know for sure what they are finding now until the study is completed. I do know that if they find their hypothesis is correct, they plan on petitioning the FDA to change their recommendation to Subutex instead of methadone to treat addiction in pregnancy.

I think it is unfair of the doctors to give Subutex to mothers instead of methadone under the pretense that it will not cause ANY withdrawal symptoms in their infants, when there is clearly research otherwise. Even if the study is successful, no one is suggesting that these infants don't withdraw, just that it may be easier on them. THAT is the information that should be given to moms, and the babies should be screened and treated as appropriate after they are born!

owlcaller · Oct 1, 2009

LoveTheNICU,

It's been a while since you sent this post, but it is a topic of great concern to me. You mention that one of your professors was doing a study on this and I'm wondering if the results are in. If so, it it possible to read the results somewhere?

thanks so much :)

LoveTheNICU · Oct 1, 2009

I don't think the results are in yet, as she was still working on the research this spring and with the time between research and publishing, I can't imagine we will see them any time soon. However, her name is Karen D'Apolito, and she has been published frequently in Neonatal literature regarding withdrawal in neonates. If you do a CINAHL or Medline search I'm certain you can find her work, as well as the new topics once they are published. I do not know what her results have been, since I graduated and we are no longer in touch!

denicu · Oct 24, 2009

I was wondering what everyone's experience has been taking care of babies exposed to subutex during pregnancy. We have mothers tell us that they were told by their Dr. that Subutex does not cause withdraw in infants. From what I have read, that is not true. In my experience it most certiantly does cause withdraw. These kids are miserable and stay in NICU for 2-3 weeks. The mothers just can't understand why their baby isn't doing well. Also, how does your unit treat withdraw symptoms. Do your docs give meds? We give the baby a neonatal abstinance score every 4 hours and sometimes medicate with morphine but our Drs. would rather not. It's terrible to watch them scream and not be able to eat. I hate to think that we are not doing everything we can to help them recover as fast as possible. Also, do you ever send these kids home with narcs when the mother obviously has an addiction. Thank you for your imput.

The few babies I have seen where mom was on Subutex did not have a long course in the nicu. In fact they were home 3-4 days without ever being on meds. Maybe they were the lucky few.

Elvish, BSN, DNP, RN, NP · Nov 2, 2009

Anecdotally, I have not seen Subutex result in less withdrawal and/or lower scores. Probably about 1/3 to 1/2 the babies we withdraw have moms who were on Subutex and I can count on one hand the number that have gone home without ever starting meds.

It's always hard to know though, because while Mom's not *supposed* to be on any other narcs, that's not always the case.

sunshine1216 · Sep 5, 2011

Hi everyone,

I just joined this forum. I wanted to ask discuss infants that go through withdrawal when their mothers take Subutex during pregnancy. I work in a special care nursery and seem to be seeing more and more of this. We do about 120-140 deliveries a month and this month had 4 babies go through withdrawal. It is so sad! I do not think the public is well educated at all about Subutex during pregnancy. Mom's consistently seem surprised when their baby's go through withdrawal and require treatment and stay in the hospital for weeks. I wish there was a way to better educate people. Also.....Methadone vs. Subutex.....I have found baby's do better withdrawing from Methadone. They show symptoms faster but are easier to wean off the tincture of opium. I am thinking this is because the dispensing of Methadone is so controlled....people have to go to the Methadone clinic to get it but with Subutex they can just get a prescription from their doctor. Seeing a baby have to go through this withdrawal is so so so heartbreaking. The way they cry and tremor is very sad. I have found that mom's who hold these baby's constantly and keep their rooms calm, quiet, and dark can help their baby's so much! It may sound strange but I have come to love caring for these baby's. When taking care of a baby for weeks and being able to hold and console them and help them is very rewarding. I really want to research this further and put something together that parents can read during prenatal visits and be prepared for infant withdrawal and everything they can do to help their baby. Unfortunately there are parents who rarely visit or call to check on these infants who stay in the hospital which is the saddest thing!....but that is another problem entirely. Does anyone have any input/suggestions for putting some informative material together? We immediately do abstinece scores every 4 hours and most babues end up on tincture of opium every 4 hours. Once the infant has 2 scores greater than or equal to 8 they start the tincture of opium. Every 12 hours if scores have been less than 8 we wean by 10%. Weaning starts after the first few days. Most infants scores shoot up after each wean for the first few scores.