Hi Liz,

Thanks for your reply on the question of working with moms who are using THC.

I think this is an intriguing question.

Yes, of course I provide medical care for anyone, whether it is resuscitation from an overdose, an infected arm from shooting up, etc.



But, what if I know that mom is under the influence of something when she comes to her appointment, and she wants help with latch?

If I have a strong suspicion that mom has heroin on board, or is drunk, and she comes in for her lactation appointment, complaining of latch issues, I would change the appointment to the topic of substance use and breastfeeding, and possibly advise mom to not breastfeed at that visit but to stop at a store and give formula. Now, of course, if she is not fit to drive and I have concerns about her care of the infant, then I would call for help.

So, what if the LC, knowing that mom is under the influence of something, helps mom latch the baby anyway, but does not talk to the mom about risks associated with substance use and breastfeeding. And then something has happened to the baby within the next day?



Thanks,

Anne





Anne Eglash MD, IBCLC, FABM

Clinical Professor, Dept of Family and Community Medicine

University of Wisconsin School of Medicine and Public Health

Director, UW Lactation Services

Medical Director, Mothers Milk Bank of the Western Great Lakes

Founder and President of The Institute for the Advancement of Breastfeeding and Lactation Education (IABLE)

www.lacted.org







Date:    Fri, 18 Jan 2019 10:08:48 -0500

From:    Elizabeth Brooks <[log in to unmask]>

Subject: Re: Positive THC



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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