Flawed Naltrexone Study Still Shapes Medical Detox in Pregnancy

A body of research that helped normalize medical detox during pregnancy is now under sustained criticism from auditors and addiction specialists, and the questions being raised go to the heart of how pregnant patients with opioid use disorder are treated today.

ProPublica reported on August 24, 2026 that a University of Tennessee audit found major problems with research by Dr. Craig Towers, a high-risk obstetrician in Knoxville whose work challenged the long-standing view that pregnant patients could not be safely withdrawn from opioids. WBUR’s Here and Now discussed the findings with reporter Amy Yurkanin on August 25.

Why Medical Detox in Pregnancy Was Considered Off Limits

Medical doctrine had long held that a pregnant patient with an opioid addiction could not be safely detoxed, because withdrawal could stress the fetus and even trigger miscarriage, according to ProPublica. The standard approach instead used methadone or buprenorphine, medications that control cravings and carry lower overdose risk.

Those medications can still result in newborns experiencing withdrawal, but clinicians reasoned that treating a newborn’s symptoms was safer than risking the pregnancy.

Towers questioned that framework. He studied outcomes for patients who stopped taking those medications, eventually collecting data on more than 300 of them, and reported that detoxing was much less harmful to the fetus than feared. Clinics in Johnson City, Jellico, and Sevierville, Tennessee, and in Daytona Beach, Florida, followed his lead.

What the Study Claimed

The 2020 study enlisted 230 participants, 121 of whom took a daily dose of naltrexone, ProPublica reported. Unlike methadone or buprenorphine, naltrexone is not an opioid.

It blocks opioid effects rather than substituting for them, which means a person must already be through withdrawal before starting it. The study reported that naltrexone was effective at keeping most participants off opioids.

Specialists found that result hard to square with the wider evidence base. ProPublica noted that a systematic review of 13 studies found relapse rates among nonpregnant patients on oral naltrexone averaged 72 percent.

What Auditors and Specialists Found

A University of Tennessee audit determined that Towers had not obtained university approval for the study, that he supplied inaccurate or unverifiable and contradictory source documentation for one component, and that he did not provide research databases or data analysis when asked.

Auditors also could not determine the extent to which he protected confidential patient health information. Eight specialists in addiction and pregnancy wrote to the university with concerns, including whether informed consent had been properly obtained and why the study reported no participants refusing or dropping out.

Dr. Mishka Terplan, an obstetrician board certified in addiction medicine, wrote that potential harm to a vulnerable population accumulates while the article remains in print. University of North Carolina researcher Hendree Jones told ProPublica it was unusual to see no serious medical events among that many pregnant patients.

Towers disputes the findings. He told ProPublica the audit reached erroneous conclusions, that he was not given a full opportunity to defend his work, and that all participants received a notice of research and chose to proceed. He said he stands by naltrexone as a treatment option.

Why This Matters for Safe Withdrawal

Withdrawal management during pregnancy is one of the highest stakes decisions in addiction medicine, and it should be made with a clinician who treats both pregnancy and opioid use disorder.

Medication assisted treatment with methadone or buprenorphine remains the approach reflected in federal and professional guidance for opioid use disorder in pregnancy.

The reporting also surfaced a clinical counterpoint. Dr. Cathleen Suto, who worked at a clinic using an approach inspired by Towers’ research, is quoted in a book saying that detox would be a great answer but that her patients were not successful at completing it. Many could not finish weaning and stopped attending the clinic.

Finding Medically Supervised Detox

If you are pregnant and using opioids, or supporting someone who is, look for a program that coordinates with obstetric care rather than treating addiction in isolation.

Ask whether the program offers medication for opioid use disorder, whether it has experience with pregnant patients and what the plan is for the postpartum period, when overdose risk rises.

Detox.com’s directory lists medically supervised detox programs by location and level of care so you can compare options that include obstetric coordination and medication-assisted treatment. Call 800-996-6135(Sponsored) to learn more about your treatment options.