Is Suboxone safe during pregnancy?

Yes. Research and national guidelines from ACOG, CDC, and SAMHSA show Suboxone (buprenorphine/naloxone) is safe and effective for treating opioid use disorder during pregnancy when medically supervised.

What happens if I stop Suboxone while pregnant?

Stopping suddenly can cause opioid withdrawal, which may lead to miscarriage, preterm labor, or relapse. Always talk to your doctor before making any medication changes.

What is Neonatal Opioid Withdrawal Syndrome (NOWS)?

NOWS is a temporary condition in which babies experience mild withdrawal after birth. Symptoms usually appear within a few days and resolve in 1–2 weeks with medical support.

What's the difference between NAS and NOWS?

Both describe newborn withdrawal, but NOWS is specific to opioid exposure, while NAS may refer to withdrawal from other substances as well.

Can I breastfeed while taking Suboxone?

Usually yes. Only tiny amounts of buprenorphine pass into breast milk, and breastfeeding can actually help reduce NOWS severity.

What are the side effects of Suboxone during pregnancy?

Most patients tolerate Suboxone well. Possible side effects include mild nausea, headache, or constipation, which usually improve over time.

Can I deliver vaginally while on Suboxone?

Yes. Suboxone does not interfere with your ability to deliver vaginally or with pain management during labor. Always inform your care team about your medication.

How long does NOWS last?

Most babies recover within one to two weeks, though some require brief observation or supportive care in the hospital.

What if I relapse during pregnancy?

You're not alone. Relapse can happen. CleanSlate offers immediate support, medication adjustments, and therapy to help you regain stability safely.

Is Subutex safer than Suboxone during pregnancy?

Both are safe. Some providers may prescribe Subutex (buprenorphine without naloxone) during pregnancy, though Suboxone is increasingly supported by research as safe and effective.

Can Suboxone be started late in pregnancy?

Yes. It's never too late to start treatment. Even beginning MAT in the third trimester can improve outcomes and reduce NOWS.

Can Suboxone affect labor pain management?

It can slightly reduce the effectiveness of some pain medications, so your medical team may adjust your labor plan accordingly. Always inform your doctors about your treatment.

How does CleanSlate coordinate with my OB-GYN?

CleanSlate works closely with your prenatal care provider to ensure safe dosing, fetal monitoring, and delivery planning. Collaboration is central to our care model.

Can I take Suboxone while breastfeeding?

Yes. It's considered compatible with breastfeeding, and most infants show no adverse effects.

Why choose CleanSlate for OUD treatment during pregnancy?

Because you deserve compassionate, evidence-based care. CleanSlate offers outpatient Suboxone treatment, behavioral therapy, prenatal coordination, and long-term support to keep you and your baby safe—before, during, and after birth.

What is the best treatment for opioid use disorder in pregnancy?

The safest and most effective treatment is medication-assisted treatment (MAT) with Suboxone or buprenorphine-only medication, combined with behavioral therapy and prenatal care.

Can you switch from methadone to Suboxone during pregnancy?

Yes, but only under close medical supervision. Transitioning improperly can cause withdrawal for both mother and baby.

Can Suboxone help prevent NOWS?

Yes. Studies show babies born to mothers on Suboxone have milder and shorter NOWS symptoms than those exposed to methadone or illicit opioids.

Does Suboxone cause birth defects?

No. Studies show no increased risk of birth defects in babies exposed to Suboxone during pregnancy compared to the general population.

Can Suboxone cause miscarriage?

No. In fact, staying on treatment helps prevent miscarriage by stabilizing maternal health and avoiding dangerous withdrawal.

What happens to babies after birth if the mother takes Suboxone?

Babies may be monitored for NOWS symptoms such as fussiness, tremors, or difficulty feeding—but these are temporary and resolve with care.

Will my baby go through withdrawal if I take Suboxone?

Possibly, but symptoms are generally mild and short-lived. Medical teams are experienced in managing this safely.

Does Suboxone affect breastfeeding or milk supply?

No. Suboxone does not reduce milk production, and breastfeeding is often encouraged.

Can I take other medications with Suboxone while pregnant?

Always consult your provider. Certain medications, like benzodiazepines or sleep aids, can be dangerous when combined with opioids.

What should I avoid while on Suboxone during pregnancy?

Avoid alcohol, benzodiazepines, stimulants, and tobacco. These substances increase the risk of complications for you and your baby.

How long should I stay on Suboxone after giving birth?

There's no fixed timeline. Many women continue treatment for months or years. Staying on Suboxone postpartum helps prevent relapse during this high-risk period.

What are the signs of opioid withdrawal in pregnancy?

Symptoms include cramping, sweating, anxiety, insomnia, and nausea. Withdrawal should never be managed alone—seek medical help immediately.

What's the first step to start treatment at CleanSlate?

Call (833) 505-4673 or schedule an appointment online. You'll meet with a provider for an evaluation and a same-day start to treatment in most cases.

Dr. William “Bill” Ruby, D.O.

Chief Medical Officer – CleanSlate Centers

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About Dr. Ruby

Dr. William “Bill” Ruby serves as Chief Medical Officer of CleanSlate Centers, providing national medical leadership and strategic direction across the organization’s multi-state outpatient addiction treatment network. A board-certified family physician and nationally recognized expert in HIV and infectious diseases, Dr. Ruby brings more than three decades of clinical, academic, and executive healthcare experience to CleanSlate.

Throughout his career, Dr. Ruby has focused on delivering high-quality care to underserved and vulnerable populations, including individuals impacted by incarceration, infectious disease, and substance use disorders. His leadership at CleanSlate centers on clinical excellence, integrated care, population health, and value-based innovation.

Education & Training

Doctor of Osteopathy (D.O.) – Ohio University College of Osteopathic Medicine
Family Practice Residency – Barberton Citizens Hospital, Ohio
Internship – Doctors Hospital of Stark County, Ohio
Bachelor of Science (Zoology) – Miami University, Ohio

Executive Leadership

As Chief Medical Officer, Dr. Ruby:

Provides national medical leadership across all CleanSlate markets
Oversees medical and clinical operations, ensuring compliant, high-quality delivery of medication-assisted treatment (MAT) and behavioral health integration
Leads Essential Care, a system-wide initiative integrating Hepatitis A/B/C, HIV, and STI screening, vaccination, and treatment into addiction medicine
Develops value-based care strategies and payer partnerships
Supervises and mentors Regional and Center Medical Directors
Directs organization-wide clinical education and training
Oversees Continuous Quality Improvement (CQI) initiatives and outcome measurement systems

Under his leadership, CleanSlate continues to expand its role in integrated addiction medicine and public health.

Clinical Expertise

Dr. Ruby’s expertise spans:

Addiction medicine and Medication-Assisted Treatment (MAT)
HIV and Hepatitis C care
Infectious disease management
Correctional healthcare systems
Telemedicine expansion for vulnerable populations
Clinical analytics and performance dashboards
Integration of physical and behavioral healthcare
Population health and value-based care models

His background in correctional medicine and infectious diseases uniquely informs CleanSlate’s commitment to treating substance use disorders within a broader public health framework.

Board Certification & Credentials

Board Certified – American Board of Family Medicine (Recertified 2021)
Diplomate – American Academy of HIV Medicine
Multiple active medical licenses across several U.S. states
DEA Registration (Active)

Previous Leadership Roles

Prior to joining CleanSlate in 2024, Dr. Ruby served as:

Chief Medical Officer – Intermountain Centers for Human Development
Chief Medical Information Officer & Chief of Infection Control – Wellpath
Associate Chief Clinical Officer – Wellpath & Correct Care Solutions
Regional Medical Director – Correctional Healthcare Systems (multi-state oversight)
Assistant Professor & Medical Director – Johns Hopkins University School of Medicine, Division of Infectious Diseases

At Johns Hopkins, Dr. Ruby served as Medical Director of the Moore Clinic and Telemedicine Programs, and led initiatives in HIV care and correctional health services

He has also held leadership roles with Gilead Sciences and state-level public health systems, contributing to infectious disease policy, pharmaceutical strategy, and correctional healthcare reform

Research & Academic Contributions

Dr. Ruby has served as Principal Investigator and Sub-Investigator on numerous NIH-sponsored and pharmaceutical clinical trials, particularly in HIV and infectious disease research

His academic work includes:

Research on HIV treatment and telemedicine in correctional systems
Contributions to infectious disease management guidelines
Publications and lectures in HIV medicine and public health

His longstanding research background strengthens CleanSlate’s evidence-based approach to addiction medicine.

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Commitment to Integrated, Compassionate Care

Dr. Ruby is a strong advocate for judgment-free, recovery-oriented addiction treatment. His work emphasizes:

Treating substance use disorder as a chronic medical condition
Expanding telehealth to increase access to care
Integrating infectious disease screening into addiction treatment
Supporting underserved communities through coordinated medical services

At CleanSlate, this vision translates into measurable quality standards, data-driven care models, and expanded access to evidence-based treatment nationwide.

Frequently Asked Questions

Working With Dr. Ruby

What is Dr. Ruby’s role at CleanSlate?

Dr. Ruby serves as Chief Medical Officer, overseeing all medical operations, clinical strategy, and quality initiatives across CleanSlate’s national network.

How does Dr. Ruby support referral partners?

He works to strengthen value-based partnerships, data-sharing initiatives, and coordinated care pathways with health systems, payers, and community providers.

Does Dr. Ruby treat patients directly?

As CMO, his primary focus is executive clinical leadership, medical oversight, and system-wide quality improvement, though his background includes extensive direct patient care in infectious disease and addiction medicine.

What distinguishes Dr. Ruby’s leadership?

His combined expertise in infectious disease, correctional medicine, clinical analytics, and executive healthcare management positions CleanSlate as a leader in integrated addiction treatment.