Breastfeeding & Drugs: Methadone

Methadone has been shown to transfer into breast milk. Blinick reported a milk/maternal plasma ratio of 0.83. This same study reports no adverse effects on the infant of being breast fed irrespective of the maternal methadone dose ( Blinick, 1975 ). Other studies show very minimal transfer of methadone into maternal milk, however several of these studies report that infants who were breastfed by their methadone using mothers had lower neonatal abstinence scores and earlier hospital discharge than infants fed formula ( Phillip, 2003 .

Geraghty studied two breastfeeding mothers on high doses of Methadone and measured milk levels along with maternal serum levels. They found very little in the breast milk ( Geraghty, 1997 ).

There is one report of a 4-week-old infant breast fed by his methadone using mother who was found dead in bed. His history was significant for poor growth, being cranky, having signs of a "cold" and refusal to feed ( Smialek, 1977 ).

Mothers may minimize the amount of methadone that the infant receives from breastfeeding by giving the infant a bottle of formula at the feeding after the dose of methadone is taken by the mother ( Lawrence, 2005 p. 414).

The AAP statement Transfer of Drugs and Other Chemicals into Human Milk has placed methadone in the "usually compatible with breastfeeding" group. This is based on the assumption that the mother is receiving methadone in a structured drug treatment program. This program should include monitoring of maternal urine to detect concomitant usage of other illicit drugs ( AAP DRUGS, 2001 ).

A report from the Center for Substance Abuse Treatment of the U.S. Department of Health and Human Services recommends that Methadone using mothers who are compliant with their treatment program should be encouraged to breastfeed ( US DHHS, 1993 ).