What is the preferred medication for heroin-addicted women during pregnancy?

Methadone is considered the preferred medication for managing heroin addiction in pregnant women. Its use effectively stabilizes these patients, allowing for a reduction in illicit opioid use while minimizing withdrawal symptoms and cravings. Methadone is a long-acting opioid agonist, which means it can provide a smooth level of medication, preventing the peaks and troughs associated with short-acting opioids like heroin. This controlled substitution therapy is crucial during pregnancy because it helps maintain maternal health and reduces the risk of complications associated with opioid withdrawal, such as preterm labor and fetal distress.

Furthermore, methadone is well-studied in pregnancy, and evidence supports its safety for the developing fetus when administered at appropriate therapeutic doses. The risks of untreated opioid addiction during pregnancy are significant, including neonatal abstinence syndrome (NAS), which can occur regardless of the treatment used but is more easily managed with a stable methadone regimen compared to continued illicit substance use.

While buprenorphine is also an effective medication for opioid dependence and is considered a good option in some cases, methadone’s established history and documented outcomes in pregnant women give it the edge as the preferred choice among treatment options available. Naltrexone and disulfiram are not suitable choices in this context