What is the recommended treatment for a pregnant woman physiologically dependent on hydromorphone?

The recommended treatment for a pregnant woman physiologically dependent on hydromorphone is agonist replacement with buprenorphine or methadone. This approach is supported by current guidelines because both buprenorphine and methadone have been shown to effectively manage opioid dependence while minimizing withdrawal symptoms and reducing the risk of adverse pregnancy outcomes. These medications help stabilize the patient's health, providing a safer alternative for both the mother and the developing fetus compared to abrupt cessation of opioids, which can lead to significant withdrawal symptoms and complications.

Using agonist replacement therapy allows for a controlled approach to treatment. Methadone and buprenorphine function as long-acting opioids that can significantly reduce cravings and withdrawal symptoms without producing the same high as hydromorphone, thus minimizing the risk of relapse into illicit drug use.

Other treatment options, such as immediate detoxification, are generally not advised for pregnant women due to the risks associated with withdrawal, which can be dangerous for both the mother and the fetus. Similarly, psychotherapy alone does not address the physiological dependence and may not provide the necessary support for managing withdrawal and cravings. Herbal remedies lack the evidence-based support and clinical safety required for use in pregnant patients and can pose unknown risks to both mother and child.