76. Injectable Buprenorphine in Pregnancy

76. Injectable Buprenorphine in Pregnancy

Curious about how different treatments might shape recovery during pregnancy? This journal club session digs into one of the first randomised trials of injectable buprenorphine in pregnant patients, and it’s aimed squarely at clinicians who want research they can actually use in practice. Dr Sonja Del Tredici and Dr John Keenan walk through a JAMA Internal Medicine trial comparing weekly extended‑release buprenorphine injections with standard sublingual buprenorphine in 140 pregnant patients.

The focus stays very practical: abstinence rates, serious adverse events, and neonatal outcomes such as neonatal opioid withdrawal syndrome (NOWS) and hospital length of stay. John admits he “was drinking the haterade” on depot buprenorphine at first, but the data won him over. Extended‑release buprenorphine showed higher illicit opioid abstinence in pregnancy and fewer serious adverse events, with no clear difference in NOWS treatment rates or infant development at 12 months.

Sonja calls it a “landmark trial in addiction medicine, especially of people who are pregnant,” and both of them emphasise how rare and valuable proper RCT data in pregnancy actually is. Beyond the main paper, they branch out into topics clinicians face every day: the “quiet relapse engine” of insurance-driven medication changes, the kindling effect in fentanyl withdrawal (using a mouse model), and the uncomfortable reality that tramadol can act as a “gateway opioid” for long-term use.

Their style is relaxed, funny in places, but very evidence-heavy, making this especially useful for addiction specialists, GPs, and perinatal teams juggling both maternal stability and infant safety. If you’re managing opioid use disorder in pregnancy or supporting patients through benefit and insurance upheavals, this conversation may help you decide what to do at the next tricky consult. How might this data shift your comfort level with depot buprenorphine in pregnant patients?