To      :Judy
Re      :Heroin and Morphine

You are technically correct that heroin (diacetyl morphine) is rapidly
converted to morphine.  As the diacetyl salt form (heroin),  it is much more
lipophilic and transfers into various peripheral compartments (brain,
breastmilk ?) much more rapidly.  Because it enters the CNS more rapidly, it
produces a greater high than does morphine by itself, hence addicts much prefer
heroin over morphine.   I have never seen a paper on the transfer of "Heroin"
itself into milk, but I'm sure it does.

I'm sure the AAP recomendations were based on the fact that morphine is an FDA
"cleared" drug,  whereas in the US,  heroin is not.  Therefore non-cleared
drugs of abuse are uniformly "contraindicated".  Not that they are more
dangerous necessarily,  just that they are "drugs of abuse" and are uniformly
discouraged.

It is highly unlikely that a breastfed infant exposed to maternal heroin would
ingest any more (morphine) than that same mother exposed to morphine,
"assumming the doses are the same".  This is a big assumption,  since heroin
addicts can tolerate enormous doses.

Regards
Tom Hale, PH.D.