What is the standard treatment for opioid use disorder during pregnancy?

• A. Suboxone taper only
• B. Naltrexone therapy
• C. No treatment recommended
• D. Methadone maintenance

Answer: (D)

Treating opioid use disorder in pregnancy aims to prevent withdrawal, stabilize the mother, and reduce harm to both mother and baby. Methadone maintenance provides a long-acting opioid agonist that keeps opioid levels steady, prevents withdrawal symptoms that can trigger uterine contractions or relapse, and supports consistent prenatal care. It has the most extensive safety and effectiveness data in pregnancy, helping improve maternal outcomes and reduce risks associated with unmanaged opioid use. While buprenorphine is also used and can have advantages in some cases, methadone still stands as the standard approach in many settings due to its proven track record.

Tapering or stopping opioids during pregnancy is risky because withdrawal can harm the fetus and increase the chance of relapse and overdose. Naltrexone is an opioid blocker and is not routinely started during pregnancy due to limited safety data and lack of evidence showing it provides the same stable treatment as opioid agonist therapy. So the recommended standard treatment is methadone maintenance.