Is Breastfeeding Always a Bad Idea When Mom is Using

    Typically moms are told to discontinue breastfeeding when they are doing drugs. But is this always the best advice? Logically, it seems like it is, but let's delve deeper as to what is best for baby. We all know breastfeeding is a good thing for baby, but what about when it is laced with drugs, specifically opioid medications, that are not good for baby? But maybe things aren't as bad as they sound.

    An article by Thomas Hale and Kaytlin Krutsch explore this perspective in more depth. It should be noted that the article mainly discusses doctor prescribed medication to a breastfeeding mother. This still causes us to ponder the use of opioids that a breastfeeding mother chooses to take for recreational use, and not prescribed for pain postpartum.

    As discussed in the article, drugs with low molecular weight transfer at high levels. Opioids would fall into this category. With that said, the consideration of all levels of transfer in breastmilk is dependent on the dosage. Another important factor is the stage of lactation. When there is exposure to a drug during the first couple days after birth, the exposure is minimal. But after 2-4 weeks, the production of milk increases dramatically, which means the exposure of drugs to the infant increases. As the infant nears 10-12 moths of age, the intake of milk is again reduced, and 12-18 months it drops even more. This means the lowest time period of risk is the very beginning of breastfeeding, as well as at the very end of breastfeeding.

    Hydrocodone, oxycodone, codeine, morphine, and other opioids are all drugs that have been prescribed postpartum. Some opioids like heroin or fentanyl are not prescribed. Methadone is often prescribed to breastfeeding mothers in treating heroin abuse. If a mother is prescribed a dosage over 180 mg, the mother is advised to stop breastfeeding. When methadone is used during pregnancy and breastfeeding, there is a high probability that the infant will be predisposed to have some degree of dependence on the drug. 

    The conclusion we come to is all opioids will transfer to human milk to some degree. Safety should always be considered in breastfeeding women. Hydrocodone has been the primary opioid used postnatally, even in breastfeeding women, with good outcomes. This is good news to women who have a tendency to be addicted to drugs, but still want to breastfeed, especially if they are trying to work at overcoming their addiction. Although we know prescribed medications have a positive outcome for mom and baby when breastfeeding is involved, this may not be the case with the other opioids such as heroin and fentanyl. A good rule of thumb is to consult with a doctor to determine what is the best route for a breastfeeding mom.

Hale, T. W., & Krutsch, K. (2021). Opioid Use in Breastfeeding Mothers and Neonatal Risks. Clinical

                                Pharmacology & Therapeutics, 109(3), 573–575. 

    

    

    



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