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Harvard Medical School

Methadone and Breastfeeding

Up until 2001, the American Academy of Pediatrics (AAP) recommended that methadone was compatible with breastfeeding in women taking less than 20 mg per day.  Because most women on methadone maintenance therapy typically require 50 to 15o mg of methadone per day during pregnancy, this meant that most women on methadone were not able to breastfeed. However, the dose restriction for methadone was eliminated in 2001, a decision driven by several studies indicating that the levels of methadone secreted into human breast milk were relatively low.

Published information regarding the exposure of infants to methadone through breast milk is sparse.  In a recent update from Motherisk, the authors note that the concentrations of methadone in the breast milk tend to be low and remain stable over time. Maternal methadone doses of 25 to 180 mg per day produce concentrations in breast milk ranging from 27 to 260 ng/ mL, leading to an average daily methadone ingestion of 0.05 mg (based on an infant’s estimated milk intake of approximately 500 mL/d). This ingested amount would be equal, in a 5-kg baby, to the ingestion of less than 1% of the maternal weight–adjusted dose (typical adult dose is 40 to 180 mg/day).

While breastfeeding provides many benefits for any newborn, there may be other benefits specific to this population.  About half of all infants born to mothers treated with methadone may experience withdrawal symptoms or neonatal abstinence syndrome (NAS).  Several studies indicate that neonatal abstinence syndrome may be less frequent or less severe in women who breseastfeed.  A retrospective study from New Zealand reviewed 121 infants of women on methadone maintenance over a 7-year period, and found that infants who were treated for NAS and who were breastfed in the hospital went home an average of 8 days earlier than infants who were formula-fed.  It is not clear if this due to the beneficial effects of breastfeeding itself or if the low concentrations of methadone in the breast milk prevent or minimize withdrawal.

Breastfeeding rates among opioid-dependent women tend to be low, with one study indicating that three-quarters of women elected not to breastfeed. Among the women who did choose to breastfeed, more than half stopped within one week.  Given there are clear benefits of breastfeeding for both the mother and the child, efforts must be made to support breastfeeding among methadone-treated women.

Ruta Nonacs, MD PhD

Abdel-Latif ME, Pinner J, Clews S, Cooke F, Lui K, Oei J. Effects of breast milk on the severity and outcome of neonatal abstinence syndrome among infants of drug-dependent mothers. Pediatrics 2006;117(6):e1163–9.

Liu AJ, Nanan R. Methadone maintenance and breastfeeding in the neonatal period. Pediatrics 2008;121(4):869–70.

Malpas TJ, Horwood J, Darlow BA. Breastfeeding reduces the severity of neonatal abstinence syndrome [abstract]. J Paediatr Child Health.1997; 33 :A38.

Meites E. Opiate exposure in breastfeeding newborns. J Hum Lact 2007;23(1):13.

Wojnar-Horton RE, Kristensen JH, Yapp P, Ilett KF, Dusci LJ, Hackett LP. Methadone distribution and excretion into breast milk of clients in a methadone maintenance programme. Br J Clin Pharmacol 1997;44(6):543–7.

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3 Responses to Methadone and Breastfeeding

  1. Jamie August 29, 2011 at 8:20 pm #

    Has anything been published regarding ADHD medication and breastfeeding, specifically concerta? I’ve received mixed reviews from doctors on whether to take Concerta while breastfeeding. Are there any current studies?

  2. Lactation Consultant May 9, 2012 at 12:34 am #

    Thank you for this article. It is very beneficial for us as lacatation consultants to have evidenced based articles to support breastfeeding in regards to instances such as women on methadone, when presenting to pediatricians and obstetricians. Thank you, thank you!

  3. Cherry October 22, 2012 at 10:21 am #

    I recently had a baby boy a little over 3 weeks ago. My entire pregnancy I was on methadone maintenance starting at 140mg and ending at 190 mg. My son was born healthy 7 lbs 7 oz 6 days before his due date. I fought to breastfeed because my pediatrician was unsure about it but lactation consultants supported me. I exclusively breastfed from 40 min. after his birth. I did not take any other drugs only my prescribed methadone and prenatal vitamin. My son came home in 5 days on his due date with no withdrawal and is now almost a month old and healthy. I still exclusively breastfeed and I am still on maintenance but lowering my dose from my pregnancy dose back to pre-pregnancy dose and soon hope to detox completely. I hope women and pediatricians read my story and advocate for these women and babies born on methadone maintenance and have positive results as I did from breastfeeding their babies. Any woman who is strictly on methadone maintenance and not taking any other drugs should be free to breastfeed for the health of the baby and the hope the woman can still find in herself to be a healthy, loving mother. If the woman in recovery wants to be a mother and only then, does she have a chance at changing both of their lives for the better.

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