I've been following the thread on methadone and wanted to add a few comments.
 I have been on the steering committee of the Perinatal Substance Abuse
Coalition of Stanislaus County for the last 4 years.  Prior to this I have
worked in Addiction Medicine (in addition to pediatric practice).  I am also
studying detox acupuncture in Stockton with a group involved in alcohol and
drug treatment sponsored by San Joachin County Drug and Alcohol programs.
Detox acupuncture is a modality that has been used for over 30 years
worldwide.  It is a non drug alternative to treating withdrawal symptoms and
maintenance of treatment and recovery.

At our 11th Annual Families, Babies and Drugs Conference (March 2), we had a
comprehensive talk on Methadone Maintenance and the Recovery of the Pregnant
Opiate Addict by John McCarthy, MD (a psychiatrist running a program for
pregnant addicts at the Bi Valley Medical Clinic Sacramento) and The 4P's of
Substance Abuse (the Problem, the Promise, the Practice and the Proposition)
by Milton Lee, MD (an OB/GYN and perinatologist with extensive expertise-
former Director of Project CSAP National Resource Center for the Prevention
of Perinatal Abuse of Alcohol and other Drugs and clinical practice in Los
Angeles).

Just a couple of salient points:

Methadone- a long acting opiate, is used in detox and maintenance of opiate
addicts.  Rapid tapering of methadone during pregnancy-not recommended-can
cause fetal problems.  An addict does not "give up" an addiction-rather goes
into treatment and recovery.  Anecdotally, the nursing babies I have worked
with whose moms were on Methadone seemed to require less intervention to
treat withdrawal than those who were bottlefed.

From  Dr. McCarthy's Talk
Outcome Information of 97 consecutive pregnancies treated at Bi- Valley
Medical Clinic
-85% in recovery at delivery (toxicology negative for drugs)
-average gestational age 35.1 weeks
-mean birth weight- 5.7 lbs
-mean height- 19"
-mean maternal methadone dose 92 mg (range 25-180 mg/day)
-mean maternal blood level 175 ng/ml (therapeutic 150-600 ng/ml)
-64% of babies had little or no withdrawal symptoms, no meds used
-36% required treatment with medications (paregoric) for withdrawal
-median hospital stay > 3 days (66% spent only 1-3 days in hospital.
Average hospital stay for newborn 8.4 days (range 1-51)
-25 patients nursed while on methadone

Breastfeeding

-Blinnick et al. in 1975 report on low levels of methadone in human milk,
nursing was allowed with no dose restrictions-In 1983 American Academy of
Pediatrics establishes sets 20n mg dose limit for nursing.  Recommendations
remain unchanged in 1989 and 1994 revisions. Six subsequent studies of
methadone levels in milk (from 1977 to 1997) conclude that levels of
methadone are too low in milk to have any adverse effect on the infant.  All
authors support nursing without dose restrictions.

Bi-Valley Study of Methadone Levels in Milk
-8 nursing mothers provided 14 samples for analysis-Average level of
methadone in milk is 0.1 mg/liter. At this level a newborn ingesting 475
ml/day of milk would ingest 0.05 mg/day of methadone.
Bi-Valley patients have nurse non methadone doses of 25-180 mg/day
-Duration of nursing was 3-24 months.  There were no adverse events
associated with nursing or weaning in this population

Anyone interested in contacting Dr. Milton Lee:

Milton Lee, MD
St. Francis Medical Plaza
3628 E. Imperial Hwy
Suite 408
Lynwood, CA 90262
310-635-5857

Pierrette Mimi Poinsett, MD FAAP
Modesto CA

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