Pat and all(Please not this has amended info Pat)

I am a pediatrician who has had many years experience working with pregnant
addicts and their children.  This is one of my primary areas of consultation.

You asked:
 I'm concerned that the methadone dose is above the 20 mg that is AAP
approved for a breastfeeding mother. And also concerned with the xanax which
has a long half life is not AAP approved.  I bear in mind that most likely
less of these drugs will come through her milk than the baby is presently
getting through the placenta.  Also I'm concerned with the baby having
withdrawal from the methadone and possible even the xanax which is quite
addictive itself.  Does anyone have any experience with addicts and babies
born to them?  What can I expect of this baby?  Will it be safe to breastfeed
and continue these drugs at these dose levels?  Any information or
suggestions will be appreciated.>>

The addicts I have worked with have been on much higher doses of methadone
during thier pregancy (70--100 mg per day) without adverse to the baby.  It
is more dangerous to try to do a rapid taper of methadone.  Ironically
methadone exposed babies have more withdrawal symptoms than heroin exposed
babies!

Methadone and breastfeeding are compatible.  Actually it is a more practical
way of weaning the baby off the methadone as mom is being weaned.

As for Xanax-this benzodiazepem has an extremely long detox/withdrawal period
can take up to 2 years for people to be symptom free.  The withdrawal can be
very nasty and associated with seizures other CNS problems.  Probably would
be less safe to do  rapid detox for mom and baby.

It would be helpful to know if mom drinks alcohol or smokes.  These are the
two drugs most clearly associated with perinatal problems. Also if she is
shooting over methadone or doing other drugs is also helpful information.

As for the weight gain during pregnancy.  My OB told me that it is
PREPREGNANCY weight that is the best predictor of outcome.  Women who lose
weight, gain minimal weight also may have healthy infants.  I can bug him for
the reference if someone really wants it.

Some Resource Information

1.Haight Ashbury Free Clinics in San Francisco-has the longest running
program for benzodiazepem withdrawal.They are also active in research,
treatment and advocacy on  chemical dependency (in all aspects)   Incredible
technical support on recovery/addiction issues.  Daryl Inaba, Pharm D. would
be the best person to contact.

2. Marty Jessup RN, MS Associate adjunct professor, Dept of Family Health
Care Nursing, University of California, School of Nursing, San Francisco.
Marty has done incredible work in the field of women's addiction and
recovery-great resource person. She is definitely one of my mentors!

3.California's Women's Commission on Alcohol and Drug Dependencies
14622 Victory Blvd, #100
Van Nuys, CA 91411
818-376-0470
[log in to unmask]

Have many useful publications, provide training conferences and have a
network of consultants that can provide useful technical support.

4. Great Book:

Chemical Dependency -Women at risk, Brenda L. Underhill and Dana G. Finnegan,
editors,Harrington Park Press, 10 Alice Street, Binghamton NY 13904-1580,
1996.

I have other resource information if anyone is interested.

Pierrette Mimi Poinsett MD FAAP
Modesto CA