Methadone and Breast Feeding
Illicit drug use and legal substance use/abuse is a significant problem among women of childbearing age. For pregnant and postpartum women, methadone maintenance has been the treatment of choice for opioid dependence in the United States, Canada, and many other countries. Since 2001, the American Academy of Pediatrics (AAP) has endorsed that methadone is compatible with breastfeeding regardless of mother’s dose. Concentrations of methadone in human milk and the effects on the infant have been well-studied. The levels of methadone found in human milk are low.
Breast milk is optimal for infant nourishment and has a positive effect on long term health for the motherinfant dyad. Specifically, breastfeeding promotes positive early infant attachment experiences and decreases maternal stress responses. Research shows breast feeding and breast milk was associated with reduced NAS severity in infants born to drug-dependent mothers. This is especially helpful to methadone-exposed infants and their mothers. Overall, methadone-maintained women have low rates of breastfeeding for a number of reasons. One barrier to breastfeeding in this group is the lack of clear, consistent messaging regarding methadone and breastfeeding from the healthcare team. For example, staff members feeding formula to an infant when stored breast milk is available. This will quickly discourage even a determined breast feeder and may confuse the infant.
The exposure of infants to methadone through their mothers’ breast milk is minimal. Women on stable doses of methadone maintenance, regardless of dose, should be encouraged to breastfeed, if desired.
Jansson, L. M., Choo, R., Velez, M. L., Harrow, C., Schroeder, J. R., Shakleya, D. M., & Huestis, M. A. (2008). Methadone Maintenance and Breastfeeding in the Neonatal Period. Pediatrics, 121(1), 106-114. Retrieved May 10, 2018, from http://pediatrics.aappublications.org/
Reece-Stremtan S, Marinelli KA. ABM clinical protocol #21: guidelines for breastfeeding and substance use or substance use disorder, revised 2015. Breastfeed Med. 2015;10:135–141.
