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©iStockphoto.com/Goldmund
by Amy Spangler
January 07, 2008
Researchers at John Hopkins University recently studied the effect of methadone on breastfeeding infants.
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 breast milk and maternal and infant blood. Samples were collected when the concentrations of methadone were highest and lowest. Breast milk 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 breast milk 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.
Editor’s Note—March 4, 2009
As further evidence of the benefits of breastfeeding for methadone-exposed babies, a study published in the BJOG: An International Journal of Obstetrics and Gynaecology found that traces of methadone in the milk of mothers being treated for substance abuse actually reduced the risk of withdrawal symptoms in their breastfed babies. According to Helen Mactier, MD, the neonatologist who headed the study, “Our research has shown that breastfeeding seems to protect against the risk of developing neonatal abstinence syndrome (NAS). The likelihood of a baby needing treatment for NAS was reduced by 50 percent in those babies who breastfed for more than three days.” Given that babies born to drug-abusing mothers are more likely to be born early (premature) and to be small for gestational age, whatever benefits breastfeeding can provide become particularly important for this population group. “Our advice is for pregnant drug misusing women to be maintained on the lowest dose of methadone compatible with stability and for them to be encouraged and supported to breastfeed,” said Mactier.
Editor’s Note—March 5, 2012
A study published in the December 2011 issue of Breastfeeding Medicine found that breast milk methadone concentrations were relatively low, even in mothers taking high doses. These results support the American Academy of Pediatrics’ recommendation that methadone dose should not be a factor in determining whether women on methadone can safely breastfeed.
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