Hi, All:  I attended a seminar at which Tom Hale presented a session on Drugs 
of Abuse, including marijuana.  His recommendations were that breastfeeding 
should be interrupted for 24-48 hours after the last dose because of the half-
life of the metabolites.  Mothers should be warned that the baby may test 
positive for days to weeks.  He gave us a list of street drugs that "require 
extreme warnings:  cocaine, LSD, phencylclidine (PCP, angel dust), other 
hallucinogenic drugs, amphetamines and IV heroin.
He said he considers PCP and cocaine probably the most dangerous of the 
street drugs, with the drug remaining in baby's system for possibly weeks after 
the last maternal dose.
He stressed that an important consideration is the metabolites (the breakdown 
products of the actual drugs) that will be passed to the baby and the half-life 
of these substances in the baby.
The social considerations would be how heavy a user the mother is, as well as 
her ability to care for her baby while under the influence.
When dealing with Child Protective Services he recommends that the LC make 
the following recommendations:
1.  assess the dependability of the mother
2.  recommend discontinuing breastfeeding in high risk mothers
3.  for low risk mothers, explain drug transfer into the milk and hazards of drug 
to baby.
4.  explain hazards of Hep B, HIV transfer via milk in unprotected babies should 
mom become infected.
5. explain that baby will be drug-screen positive for LONG periods.
6.  legal consequences of drug-screen tests in babies.

When dealing with physicians, he makes the following recommendations:
1.  remind dr. of importance of breastfeeding - risk vs. benefit
2.  remind dr. that drugs of abuse are largely only dangerous for a brief 
interval following use.
3.  counsel the mother strongly and reiterate to dr.
4.  recommend that the mother be re-screened several weeks to 1 month PP.  
If mom tests positive for heroin, cocaine, amphetamines, or hallucinogens, she 
should stop breastfeeding.
5.  screen the baby.
The drug most of us get asked about the most is probably alcohol.  Tom 
discussed the following:
1.  alcohol readily exchanges with milk and plasma.
2.  he cited one study that showed after mom's alcohol ingestion, a 23% 
reduction in the amount of milk baby took in.  May be due to taste of milk or 
alcohol's effect on oxytocin release.
3.  prolactin may be inhibited, but not definitely known.
4.  maternal blood levels have to reach 300mg% before significant side effects 
noted in baby.
5.  avoid breastfeeding for 2-3 hours.
6.  resume breastfeeding after moderate use as soon as she feels normal 
(usually 2 hours).
7.  recommend interrupting breastfeeding for 1 hour/drink or until sober.

Sorry for the length, but this session is probably the most comprehensive I 
have heard re: substance abuse.

Pam Hirsch, BSN,RN,IBCLC
Clinical Lead, Lactation Services
Advocate Good Shepherd Hospital
Barrington, IL   USA

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