Breastfeeding should be encouraged in women who:
- are stable on their opioid agonist
- not using illicit drugs
- have no other contraindications (e.g. HIV+)
Common types of prescription opioid drugs are:
- oxycodone (Percocet), hydrocodone (Vicodin), morphine and methadone.
Guidelines for using opioid drugs to treat pain in women who are pregnant or breastfeeding:
- When choosing treatment for acute pain in mothers who are breastfeeding, non-opioid pain medicine like acetaminophen (Tylenol) should be used first.
- Aspirin should be avoided, as it stays in mothers’ milk for up to 24 hours, and the newborn’s ability to break it down and get rid of it is slow.
- Early breastfeeding by mothers who received opioid drugs during delivery results in little risk to the baby. However, breastfeeding babies will be exposed to any drugs taken by their mothers after delivery.
- To reduce drug transfer to the baby through breast milk, medicines should be taken after breastfeeding if possible, to increase the time between taking the medicine and breastfeeding.
- To reduce drug transfer to the baby through breast milk, medicines should be taken after breastfeeding if possible, to increase the time between taking the medicine and breastfeeding.
- The amounts of codeine and morphine in breast milk are equal to or somewhat more than the mother’s amounts.
- If a narcotic pain medication is needed, experts recommend no more than 2-3 days of morphine.
- Codeine is not recommended for breastfeeding mothers.
- Normeperidine (from Demerol) can pass into breast milk. Its half-life is much longer in newborns, so repeated use should be avoided.
- Abruptly stopping opioid drugs that babies were exposed to in the mother’s womb can cause them to have withdrawal symptoms (trembling, irritability, excessive & high pitched crying, hyperactivity, tight muscle tone, sleep problems, seizures, poor feeding, vomiting, & diarrhea).
- Breastfeeding should be encouraged in opioid-dependent mothers maintained on buprenorphine (Suboxone, Subutex): or methadone if there are no medical reasons to avoid breastfeeding with these exceptions:
- urine drug screens positive for illicit drugs
- positive HIV test
- and/or other existing medical and/or psychiatric reasons to avoid breastfeeding
- Breastfeeding should be encouraged in opioid-dependent mothers maintained on buprenorphine (Suboxone, Subutex): or methadone if there are no medical reasons to avoid breastfeeding with these exceptions:
- Health care providers should use caution when prescribing oxycodone (Percocet) to breastfeeding mothers, especially in the first two months after delivery. Oxycodone may cause the baby to be too sleepy and difficult to wake up.
- Health care providers should refer to existing guidelines and consult with a substance abuse treatment provider.
Provider Resources
AAP POLICY STATEMENT: Breastfeeding and the Use of Human Milk (Pediatrics, 2022)
- Adequately nourished narcotic dependent mothers can be encouraged to breastfeed if they are enrolled in a supervised methadone maintenance program and have negative screening for HIV and illicit drugs.
ACOG COMMITTEE OPINION: Breastfeeding Challenges #820 • Feb. 2021
ACOG COMMITTEE OPINION: Opioid Use and Opioid Use Disorder in Pregnancy # 711 • August 2017
- Women on stable doses of methadone maintenance should be encouraged to breastfeed if desired, irrespective of maternal methadone dose
- Reduced severity and duration of treatment of Neonatal Abstinence Syndrome (NAS) when mothers on methadone maintenance therapy breastfeed
- Buprenorphine (Suboxone, Subutex): breastfed infants had less severe NAS and were less likely to require pharmacological intervention than the formula-fed infants
- Opioid Agonist Pharmacotherapy = Medication Assisted Treatment
- Prevents opioid withdrawal symptoms
- Prevents complications of nonmedical opioid use
- Improves adherence to prenatal care
- Improves adherence to addiction treatment
- Reduces risk of obstetric complications
- Does lead to expected and treatable NAS in the infant
