Addiction & CHW Integration Insights

Volume 1, Issue 1 — February 2025 Mono or Combo: Comparative Safety of In Utero Exposure to Buprenorphine Combined with Naloxone vs. Buprenorphine Alone By Dr. Ali ABY Muhammed, CHW Workforce Development Leader

Abstract

The comparative safety of buprenorphine–naloxone versus buprenorphine alone during pregnancy remains a subject of clinical debate. This review examines the findings of Straub et al. (2024), situating them within the broader context of community-based addiction care and CHW-supported treatment adherence. Evidence suggests that the combination formulation does not significantly increase adverse neonatal outcomes and may be a viable option when diversion risk is a concern. Implications for CHW practice are discussed.

Introduction

Pregnant individuals with opioid use disorder (OUD) face unique challenges in accessing safe, effective, and stigma-free care. Buprenorphine has been a cornerstone of medication-assisted treatment (MAT) in pregnancy. Traditionally, clinicians preferred the mono formulation during pregnancy to avoid exposing the fetus to naloxone. However, newer data suggest the combination product may not carry significant additional risk.

This journal entry reviews the 2024 JAMA article by Straub et al. and explores how these findings intersect with CHW roles in supporting pregnant individuals in recovery.

Study Summary

Straub, L., Bateman, B. T., Hernández-Díaz, S., Zhu, Y., Suarez, E. A., Vine, S. M., Jones, H. E., Connery, H. S., Davis, J. M., Gray, K. J., Lester, B., Terplan, M., Zakoul, H., Mogun, H., & Huybrechts, K. F. (2024). Comparative safety of in utero exposure to buprenorphine combined with naloxone vs buprenorphine alone. JAMA, 332(10), 805–816. https://doi.org/10.1001/jama.2024.11501

Key findings:

• No significant difference in rates of preterm birth, low birth weight, or neonatal opioid withdrawal syndrome (NOWS) severity between groups.

• Maternal treatment retention and adherence were similar.

• Potential reduction in diversion risk with the combination product.

Implications for Practice

From a CHW perspective, these findings expand the range of safe treatment options for pregnant individuals with OUD. CHWs can play a vital role in:

• Educating clients on available MAT options and their relative risks/benefits.

• Supporting adherence through appointment reminders, transportation assistance, and medication monitoring.

• Addressing stigma and misinformation in both community and healthcare settings.

Conclusion

The evidence from Straub et al. (2024) supports the safe use of buprenorphine–naloxone in pregnancy under clinical supervision. CHWs are uniquely positioned to bridge research findings to real-world patient care, ensuring that treatment decisions are informed, stigma-free, and tailored to individual needs.