Methadone Compatible With Breastfeeding
January 7, 2008 by Amy Spangler | 7 questions or comments
Baby Breastfeeding
Two groups of women undergoing methadone treatment for drug addiction were included in the study—one group breastfed the other formula-fed. On days 1, 2, 3, 4, 14, and 30 after birth, researchers measured the methadone concentrations in samples of breastmilk and maternal and infant blood. Samples were collected when the concentrations of methadone were highest and lowest. Breastmilk samples included both foremilk and hindmilk. Urine testing was performed at 36 weeks gestation and 30 days after birth to confirm that the participants were not using illicit drugs during the study period.
Results showed that the concentrations of methadone in breastmilk were very low (21-362 ng/mL) regardless of the maternal dose. Concentrations of methadone in maternal blood were similar in both groups and were not related to the maternal dose. Concentrations of methadone in infant blood were quite low (2.2-8.1 ng/mL) in both groups of infants. There was no difference in neurobehavioral outcomes based on a neurobehavioral assessment on days 3, 14, and 30.
While fewer infants in the breastfed group required treatment for neonatal abstinence syndrome, the difference was not statistically significant. The results of this study support the current American Academy of Pediatrics recommendation that women taking methadone be encouraged to breastfeed.
The Centers for Disease Control and Prevention (CDC) estimate that there are nearly one million people in the U.S. addicted to heroin and other narcotics (such as oxycontin, dilaudid, and hydrocone). Methadone is considered a safe and effective treatment that has been used for more than 30 years to treat narcotic addiction. Taken orally once a day, methadone suppresses narcotic withdrawal for between 24 and 36 hours. Because methadone is effective in eliminating withdrawal symptoms, it is used to detoxify opiate addicts. It is only effective in cases of addiction to heroin, morphine, and other opioid drugs, and it is not an effective treatment for other drugs of abuse. Many methadone patients require continuous treatment, sometimes over a period of years. However, methadone treatment has been shown to improve pregnancy outcomes and family stability.
I have been on methadone during my entire pregnancy. I gave birth to a healthy baby girl. She only spent five days in pediatric unit to check for any withdrawal symptoms were there. She did extremely well, showing almost no sign of withdrawal. I was thrilled! I got to take her home. I breastfed her since she was born and had been told it would be ok to breastfeed, and that it might even be best for her. Everything was going good for the first 6 weeks. The breastmilk didn’t seem to be enough for her and I was not lactating all that well, so with ok from her doctor I decided to bottle feed her as well as breastfeed. Before I knew it she was getting more bottles than breast. She also became extremely FUSSY, I mean like colicky and inconsolable. The doctors checked several times and said she was very healthy and maybe she did have colic or a growth spurt, or it could be the kind of formula. I want to know if her fussy behavior could be a result of her getting less breastmilk with small amounts of methadone in my milk? I feel so guilty. I would not have breastfed her if I had known that stopping at some time could be bad for her, nobody ever told me that. Could it really be possible? What are the side effects of stopping breastfeeding ,while on methadone, for the baby? Please help me with these questions if you can.
SINCERLY,
MRS. KOVAL
Hi Desiree,
First of all, congratulations on the birth of your daughter! You have certainly done a wonderful job. She is lucky to have such a conscientious mother. The advice you were given is correct, it was ok to breastfeed and breastfeeding is certainly best for you and your baby.
Most studies show that only small amounts of methadone pass into breastmilk, so it is unlikely that your daughter’s fussiness is due to her getting less breastmilk containing methadone. However, the amount of methadone in breastmilk depends largely on the amount of methadone the mother is taking. I am not aware of any side effects from stopping breastfeeding while on methadone, and would guess that the symptoms you are seeing are unrelated to the methadone, but your health care provider can advise you best.
Many mothers worry that they are not making enough milk, and offer infant formula in addition to breastmilk. Unfortunately, the more formula you offer, the less breastmilk you make. You can try to recover your milk supply by increasing the number of breastfeedings and or breast pumpings. How successful you will be depends on how long it has been since you decreased or stopped breastfeeding. It would be best to contact an International Board Certified Lactation Consultant (IBCLC) in your area for assistance.
Without seeing your baby, I would be inclined to think the fussiness is more likely related to the formula she was given. In the beginning, most babies have immature gastrointestinal (GI) tracts that are best suited to human milk. While it could be a growth spurt, growth spurts usually resolve after several days of more frequent feedings.
I truly don’t think it’s anything you have done, but without seeing your baby, it is difficult to assess the situation thoroughly. I encourage you to contact your baby’s doctor, nurse, or lactation consultant.
Warmly,
Amy
I HAVE BEEN ON HYDROCODONE FOR ABOUT 2 AND HALF YEARS I TOOK IT THROUGH MY WHOLE PREGNANCY EXCEPT THE LAST MONTH. SINCE THEN MY DOCTOR TOOK ME OFF OF IT AND PUT ME ON METHADONE FOR PAIN. I’M VERY CONCERNED THAT MY BABY GIRL WHO’S 4 MONTHS OLD WILL HAVE SOME HORRIBLE SIDE EFFECTS FROM THE METHADONE. I DON’T KNOW IF I SHOULD BREASTFEED ANYMORE. I WOULDN’T BE ABLE TO LIVE WITH MYSELF IF SOMETHING BAD HAPPENED TO HER ALL BECAUSE I HAD TO TAKE THIS NEW MEDICINE AND DIDN’T STOP BREASTFEEDING. I LOVE BREASTFEEDING. I HAVE BREASTFED ALL THREE OF MY CHILDREN AND I DON’T WANT TO STOP! I JUST WANT TO KNOW WILL SHE BE OK IF I CONTINUE TO BREASTFEED? OR SHOULD I STOP AND GIVE HER A BOTTLE? YUCK!! I WILL DO WHAT’S BEST FOR MY CHILD NO MATTER WHAT. PLEASE LET ME KNOW WHAT YOU THINK
YOURS TRULY KC
Available data suggest that mothers who take methadone can safely breastfeed. In any situation where medication is necessary, consideration must be given to the benefits as well as the risks. Most often, the known benefits of breastfeeding far outweigh the theoretical risks of a specific medication. Hopefully the results of the study done at John Hopkins and reported above will give you some measure of reassurance. If you are still concerned, it is best to talk with your doctor or your baby’s doctor.
I recently gave birth to a beautiful baby boy, I have been on methadone throughout the entire pregnancy. I was unable to breastfeed for the first few days because of issues in the hospital. I’m pumping and giving him the milk since discharge from the hospital. He is 4 days old. Now he has not had a bowel movement in two days. Can the small amount of methadone he is getting from my milk cause him to become constipated? It is going on the third day now and I am starting to get worried. Is this normal for a baby being breastfed by a mother on methadone? If so what can I do to resolve this problem?
I am less concerned about the methadone and more concerned about the fact that your baby has not had a bowel movement for two days. Exclusively breastfed or breastmilk fed babies usually have 3-4 bowel movements a day by day 4. Please contact your baby’s health care provider right away, so that you can be sure your baby is getting enough to eat.
While mothers who take methadone can safely breastfeed, your baby’s age, weight, health and the amount of methadone taken during pregnancy and while breastfeeding are all factors that must be considered. Mother’s taking methadone should see a health care provider regularly and participate in a structured drug treatment program. If you are under the care of a health care provider and participating in a treatment program, I would suggest that you contact your health care provider right away to see if methadone can cause constipation. Every baby is different, but it’s important to have both you and your baby evaluated.
When stopping breastfeeding while on methadone which is the best method if any is even needed. I was told that the baby would need to be weaned off the breastmilk. Having not breastfed my first two children due to methadone, I am trying to do what is best for my son. I have been told many different things about this with no clear answer yet. Thank you.