Buprenorphine: Office-Based Medication-Assisted Treatment or OTP

Buprenorphine is a partial mu opioid-agonist approved for the treatment of opioid-use disorders. Unlike methadone, buprenorphine can be prescribed both in medical offices and in opioid-treatment programs. SAMHSA’s Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction[1] outline the background of office-based medication-assisted therapies and provides guidance to prescribers on the management of opioid-dependent persons. Buprenorphine is available under several brand names that contain a combination of buprenorphine and naloxone, including Suboxone, Zubsolv, and Bunavail, as well as Subutex, which is buprenorphine alone.


Studies have found buprenorphine to be safe and effective in the treatment of opioid-use disorders during pregnancy.[2] However, because it is a relatively newer medication, there is a lack of data on the long-term outcomes of neonates exposed to buprenorphine in utero, and women seeking treatment should be informed of this gap. Nonetheless, the relative risk/ benefit may favor buprenorphine even if the woman is pregnant but otherwise a candidate for buprenorphine therapy. The available data suggest that as compared with no treatment, treatment with buprenorphine provides better outcomes for mother and newborn.[3]


Candidates for buprenorphine are women who were stable on buprenorphine before pregnancy or those who are unable to attend an opioid treatment program that uses methadone. Pregnancy does not automatically make women candidates for office-based therapy with buprenorphine, even if buprenorphine is the only medication available in the community. Moreover, the woman’s engagement in counseling and other services during pregnancy is vital for successful postpartum transition and recovery.



[1] Center for Substance Abuse Treatment. Clinical guidelines for the use of buprenorphine in the treatment of opioid addiction. Treatment Improvement Protocol (TIP) Series 40.(Publication No. SMA 04-3939). Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004.
[2] Jones HE; Heil, SH; Baewert, A. et al. Buprenorphine treatment of opioid-dependent pregnant women: a comprehensive review. Addiction. 2012 Nov;107 Suppl 1:5-27. doi: 10.1111/j.1360-0443.2012.04035.x.
[3]Jones HE; Finnegan LP, Kaltenbach K. Methadone and buprenorphine for the management of opioid dependence in pregnancy. Drugs. 2012 Apr 16;72(6):747-57.doi: 10.2165/11632820-000000000-00000.