The question is posed: "Are there any legal ramifications for an IBCLC that
helps a mother breastfeed who tests positive for THC and/or another illicit
drug ?"

The short answer is: Only if you **sold** the illegal drug to the patient,
in a state that criminalizes its use.

The longer answer asks us to use a smidge of common sense.  Healthcare
providers take their patients as they find them. If they have substances in
their system that shouldn't be there, we have to deal.  Imagine what would
happen if we failed to treat every opioid overdose that arrived in the
Emergency Room, or drunk driving victim, or accidentally-poisoned child
because they didn't know those pills in their big brothers' pockets were
bought on the street.

There is considerable debate now, in Lactation Land, about cannabis use ...
since many states in the USA are de-criminalizing social use.  And THC (the
get-high ingredient) acts differently than CBD (with no psychotropic
effects on the user).  Research in the area has historically been scant,
and poor.  Newer research cautiously suggests that the impact on the baby
of ingesting milk of a THC user is not as grave as we once surmised BUT the
studies have been on small groups, are on smoked THC only -- we know bupkus
about ingested cannabis -- and no one is willing yet to give cannabis a
full thumbs up.

This should be approached like **any** risk-benefit discussion with **any**
patient we work with.  We counsel folks not to smoke cigarettes, not to
over-indulge in alcohol, not to eat bad-for-you foods if obesity or
diabetes or heart disease is an issue.  We counsel folks to use a car seat
when driving kids, to cover up electric outlets, to move poisonous cleaners
out of reach.  And all day every day people don't heed the advice.  And
that is the nature of autonomy.   In the states where it is
de-criminalized, health care providers are (generally) telling parents not
to use THC and BF -- but leaving the decision in the parents' hands of who
they will feed their baby.

We don't "punish" folks for these failures of self-care by withholding
best-practices health care, and we are not "responsible" for their
actions/conduct.

Liz Brooks, JD, IBCLC, FILCA
Wyndmoor, PA, USA
Director, Human Milk Banking Assn of North America (2015-19)
"IBCLCs empower women and save babies' lives!"-Ursuline Singleton

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