Do not stop taking opioids because you are pregnant

Opioids — oxycodone, hydrocodone, fentanyl, tramadol, and the illegal drug
heroin — are prescribed for pain after a major injury or surgery, for severe
pain from conditions such as cancer, and sometimes for chronic pain. **Used
short-term and as prescribed, they are generally safe.** Anyone taking them is
at risk of opioid use disorder and overdose, and misuse raises that risk.

**Taking opioids during pregnancy can cause problems for both mother and
baby.**

The advice that runs against instinct

**If you have been taking opioids and you become pregnant, contact your
provider. But do not stop taking the opioids on your own.**
>
**Stopping suddenly could cause severe health problems for you or your baby.
In some cases, stopping suddenly during pregnancy may be more harmful than
taking the medicines.**

That is the most important paragraph on the subject, and it is the opposite of
what most people would do. A positive pregnancy test is exactly the moment
someone decides to stop everything — and here that decision is itself a
danger.

The same holds for opioid use disorder: **if you are pregnant and have OUD, do
not stop suddenly. See a provider and get help.**

The risks of taking them

• Neonatal abstinence syndrome — withdrawal in the newborn: irritability,
  seizures, vomiting, diarrhoea, fever, poor feeding
• Neural tube defects — of the brain, spine or spinal cord
• Congenital heart defects
• Gastroschisis — a defect where the intestines protrude through a hole
  beside the navel
• Miscarriage (before 20 weeks) or stillbirth (at 20 weeks or later)
• Preterm delivery — before 37 completed weeks
• Stunted growth, leading to low birthweight
• Problems with the placenta

If a provider suggests opioids during pregnancy, **discuss the risks and
benefits first**. If you both decide they are needed, minimise the risk by
taking them for the shortest time possible, at **the lowest dose that
helps**, following instructions carefully, reporting side effects, and going
to every follow-up appointment.

Treatment in pregnancy

For opioid use disorder, the treatment is **medication for opioid use disorder
(MOUD)**. **In pregnancy, providers prescribe either buprenorphine or
methadone** — these reduce cravings and prevent withdrawal.

Counselling and behavioural therapies alongside help change attitudes and
behaviours around drug use and build life skills.

Breastfeeding

If you regularly take opioid medicines you may be able to breastfeed — it
depends which medicine. **You should not breastfeed if you have HIV or take
illegal drugs.** Check with your provider first.

Source: MedlinePlus, U.S. National Library of Medicine.