| Pros |
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- Ability to be treated in a private office setting without the need for daily visits to a licensed treatment program
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- Dosing of buprenorphine is similar to that in nonpregnant women
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- Insurance in the United States may cover buprenorphine prescribed by a private physician in an office setting, while not covering methadone dispensed in a licensed opioid treatment program
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- Low risk of adverse cardiovascular side effects (by contrast, methadone is associated with small increase in risk of arrhythmia)
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- For the newborn, in utero exposure to buprenorphine rather than methadone may result in a lower risk of preterm birth, higher birth weight, larger head circumference, and a lower rate and severity of neonatal withdrawal
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| Cons |
- Relative to methadone, fewer data are available on pregnancy outcomes after first trimester exposure
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- Lack of long-term neurodevelopmental outcome data
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- Clinically important patient dropout rate due to dissatisfaction with the drug
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- More difficult induction protocol with the potential risk of precipitated withdrawal
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- Increased risk of diversion* (especially the buprenorphine monotherapy formulation)
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- Less stringent structure of some office-based treatment programs
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- Reports of maternal hepatic dysfunction and elevated transaminases
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- Effects of buprenorphine are only partially reversible by naloxone
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- The maximum daily dose of buprenorphine is 32 mg, due to a ceiling effect, which may not be sufficient in all women (usually those requiring more than 140 mg per day of methadone)
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- More expensive than methadone
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- Treatment with methadone may result in greater reduction in illicit opioid use
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