Opioid dependence in pregnancy is a challenge. Ongoing opioid use is associated with inadequate antenatal care and several obstetric complications. Pregnancy makes the opioid-dependent women highly motivated to engage in the treatment for drug dependence that will benefit her and her unborn child. We describe a case of opioid dependence in pregnancy. The choice of opioid substitution therapy and neonatal abstinence syndrome is also discussed in this case report.