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Low-dose Buprenorphine Initiation in Pregnancy: A Systematic Review.
Kyle A Grenier1, Carly S Sanderson, Giuliano Paoletta
1University of Connecticut School of Pharmacy, Storrs, CT (KAG, CSS, GP, KKA).
Journal of Addiction Medicine
|July 17, 2025
Summary
Low-dose buprenorphine initiation (LDBI) in pregnant patients showed uncommon precipitated withdrawal. Some withdrawal symptoms were frequent, but more research is needed to confirm findings.
Area of Science:
- Obstetrics and Gynecology
- Addiction Medicine
- Pharmacology
Background:
- Traditional buprenorphine initiation requires opioid withdrawal.
- Low-dose buprenorphine initiation (LDBI) was developed to avoid this prerequisite.
- LDBI is increasingly used for opioid use disorder treatment in pregnant individuals.
Purpose of the Study:
- To determine the rates of withdrawal in pregnant patients transitioning to buprenorphine using LDBI.
- To assess the safety and tolerability of LDBI in this population.
Main Methods:
- Systematic literature review of Embase, MEDLINE, Scopus, Google, Google Scholar, and clinicaltrials.gov.
- Inclusion of observational studies evaluating LDBI in pregnant patients.
- Extraction of patient data and synthesis of withdrawal outcomes.
Main Results:
- Seven observational studies with 25 unique patients were included.
- Precipitated withdrawal occurred in 8% of patients.
- 32% of patients experienced mild to moderate withdrawal, though reporting was inconsistent.
Conclusions:
- Emerging evidence suggests LDBI is feasible in pregnant patients.
- While some withdrawal is common, precipitated withdrawal is infrequent.
- Further high-quality research, including randomized controlled trials, is necessary to confirm these findings and address potential biases.
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