Just a second.  There is more to whether a drug can be used during
lactation than numbers.  If there is no choice to using a particular
drug, and if that drug must be used, one has to look at relative
risks.

Now, a woman who is a drug abuser is usually in a social situation
where the baby has an increased risk of morbidity and mortality.  To
state that there has been one case report of death in a baby whose
mother was on methadone, does not prove that the baby died from
methadone.  Even if it did die of methadone, many more than one child
has died of amoxycillin (anaphylaxis), or cotrimoxazole
(Steven-Johnson syndrome) or any other drug we give out often for no
good reason.  Nobody is suggesting children not get these medications.
And many more babies have died from not being breastfed, especially in
the context of a drug abusing household.

Perhaps use with extreme caution, but I like to think I use every drug
with extreme caution, not only for breastfeeding mothers.

So, L. Jonathan Kramer, I would say, get a little more flexible.  Look
at the whole picture.  It may be appropriate to suggest the mother not
breastfeed, but it may be appropriate to encourage her to do so.  And,
the final decision is still hers.

Jack Newman, MD, FRCPC