Can Opioids Be Passed in Breast Milk?

Yes, Opioids can pass from a mom to her baby through breast milk. Every type of opioid is a little different, and some are considered a little safer than others .[1]

If you’re using illicit opioids like heroin or fentanyl, this can be unsafe for babies, and you should seek treatment. If however, you are taking an opioid for MAT (Medication for Addiction Treatment), either Methadone or Suboxone, it is usually safe overall to continue to breastfeed your baby. While there are always small risks, it is generally thought that the benefits of MAT therapy outweigh the risks. Most providers encourage women to continue their MAT therapy while they continue to breastfeed, particularly if they were on MAT during their pregnancy. 

Opioid Medications & Your Breast Milk 

Opioid painkillers do pass through breast milk to a certain extent. If you are taking high doses or illicit opioids, this can cause life-threatening complications in babies including respiratory depression.[2] Using painkillers while breastfeeding can cause these issues in babies:[3]

• Drowsiness
• Central nervous system depression (slow breathing or cool body temperature)
• Death

Opioids come in many forms and the risks vary greatly depending on the type of opioid, and the dose. For example, it is never safe to use heroin or fentanyl while breastfeeding. However, if you are on an opioid based medication for OUD such as Suboxone or Methadone, these medications may be safe to continue during breastfeeding. 

Buprenorphine & Your Breast Milk 

MAT programs combine medications with therapy to help people stop using and misusing opioids. Buprenorphine-based medications like Suboxone are often used in MAT, and this medication is generally safe for a baby.

Studies show that babies don’t ingest and metabolize much buprenorphine from breast milk.[5] Researchers think that the drug isn’t bioavailable via breast milk, so it’s hard to pass the medication from a mom to her baby.[6]

Breastfeeding allows you to bond with your baby and take an active role as a parent. Caring for your baby could also encourage you to stick with your treatment plan and avoid relapsing to street drugs.[7]

The decision to continue Suboxone or Methadone during breast feeding is complicated and individual. It may be safe and even recommended for some women. Other women may decide that they prefer not to take the risk and decide to formula feed instead. There are a multitude of options – talk openly with both your Suboxone/methadone provider as well as your obstetric provider about your options and what makes the most sense for you and your baby. 

Opioids & Breast Milk FAQs

Can you breastfeed while taking opioids? 

It depends. Opioids come in many forms, both legal and illegal. Illegal substances like heroin and fentanyl are NEVER safe to take while breastfeeding. Conversely, opioid-based therapies like Methadone and Suboxone do have some risks but generally are recommended to be continued, potentially even while breastfeeding. If you have specific questions about what opioids you can and cannot take while breastfeeding, talk to your addiction specialist and/or your obstetric provider. 

If I chose not to breastfeed while on opioids, what are my other options? 

Breastfeeding does have some known benefits for both moms and babies. Breastfeeding helps with natural mother-child bonding, can help women lose weight postpartum, can provide added immunity to babies, etc. That being said, many women choose not to breastfeed while on Methadone or Suboxone, which is totally reasonable. If you decide not to breastfeed, formula feeding is always an option if it makes more sense for you.

Sources

1. The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics. Pediatrics. https://publications.aap.org/pediatrics/article/132/3/e796/31630/The-Transfer-of-Drugs-and-Therapeutics-Into-Human?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000. September 2013. Accessed August 2022.
2. Keeping Breast Milk Safe and Healthy. March of Dimes. https://www.marchofdimes.org/baby/keeping-breast-milk-safe-and-healthy.aspx#. March 2019. Accessed August 2022.
3. Morphine. Drugs and Lactation Database. https://www.ncbi.nlm.nih.gov/books/NBK501237/. April 2022. Accessed August 2022.
4. Oxycodone. Drugs and Lactation Database. https://www.ncbi.nlm.nih.gov/books/NBK501245/. July 2022. Accessed August 2022.
5. Transfer of Buprenorphine Into Breast Milk and Calculation of Infant Drug Dose. Journal of Human Lactation. https://pubmed.ncbi.nlm.nih.gov/19136395/. May 2009. Accessed August 2022.
6. Buprenorphine. Drugs and Lactation Database. https://www.ncbi.nlm.nih.gov/books/NBK501202/. June 2022. Accessed August 2022. 
7. Breastfeeding and Neonatal Abstinence Syndrome. Medela. https://www.medela.us/breastfeeding-professionals/blog/breastfeeding-and-neonatal-abstinence-syndrome. January 2017. Accessed August 2022.