Although this question was asked of Dr. Hale, I would like to add my
opinion here as well.

There should be no intrinsic difference between heroin and morphine with
regard to whether a mother can breastfeed while taking it.  The issue, I
would guess, is one of the difference between "drug abuser" and patient.

It is interesting that the treatment of withdrawl symptoms in newborn
babies addicted to narcotics often includes an intravenous drip of
morphine with weaning of the dose as the baby responds.  To not allow a
mother to nurse her baby because of the tiny amount more of the narcotic
the baby receives from the milk, is, in my opinion, somewhat bizarre,
since the baby is already getting the morphine, and if he is not, the
tiny bit in the milk, if it has any effect, will decrease the symptoms,
if anything.

Lawrence states that drug addicted mothers should only be allowed (!!)
to nurse if they are committed to not using while they nurse.  However,
I have found, in my very limited experience, that, sometimes,
encouraging a drug addicted mother to nurse her baby gives her the
motivation to kick her habit.  Isn't it better that the mother be
encouraged to nurse her baby, perhaps even to "bond" with him, and find
a greater reason and purpose in her life than drugs?  Isn't it possible
such a thing could happen?  If not for her baby, for what other reason?
Why not grab such an opportunity, even if it does not work out 9 times
out of 10.  The tenth time will have been worth it.

The infants of women who abuse drugs are at risk for increased mortality
and morbidity for many reasons. Many of these risk factors can be
decreased by breastfeeding.  Breastfeeding would be very important for
these babies.

This is a difficult question, more complicated than bactrim or
metronidazole.  But I think that the mother and baby should be given a
chance.  And if the baby nurses well, I have seen amazing changes in the
mother merely from nursing.

Jack Newman, MD, FRCPC