An assessment of the risks associated with breastfeeding by an opioid-dependent mother, in terms of sustaining successful breastfeeding and possible exposure of the infant to opioids, will need to be undertaken before considering the additional risks of exposing the infant to drugs used to treat the mother’s dependence.
Methadone is the mainstay of the treatment of opioid drug dependence and breastfeeding has benefits to an infant who has been exposed in utero to maternal opioids. There is less evidence and experience for the use of buprenorphine, which is considered compatible with breastfeeding for short-term use.
Monitor infants for drowsiness, adequate weight gain, respiratory problems and developmental milestones, especially in younger (up to one month), exclusively breastfed infants.
Acting Co-Director, West Midlands Medicines Information Service & UK Drugs in Lactation Advisory Service