A few thoughts to further "muddy the waters"
The whole subject of moms who are using "recreational" drugs and
breastfeeding can certainly be complex.  For some moms who are
highly motivated, wanting the best for their infants including
nursing can be a strong motivation to stay clean.  On the other
hand, the need for the drug once hooked can often overpower the best
of intentions without strong help and imposed restrictions such as
in a treatment setting.  The benefit/risk ratios are also an
important consideration.  In addition, it is important to consider
that in some cases there may be less than altruistic motivations.
It's important to be sensitive to the messages a mom may be
sending.  Without training in the area of drug use and rehab, we may
be overstepping our area of expertise to simply state that benefits
of nursing are stronger than real or hypothetical risks of the drug
a baby may get via the milk.
case in point: I have heard that in some cases a mom using an IV
drug has opted to breastfeed not because of her concern for her
infant getting the best, but because she has heard the veins in the
breast are more prominent during lactation and she is looking for
new sites since those in her arm or other locations are "shot"!  I
would hate to think I had supported a mom to breastfeed in this
circumstance.  Also I seem to remember one of Chasnof's early
reports of a mom who "celebrated" the baby's arrival with cocaine,
nursed the baby a little later and the baby had heart failure.
I believe it was the most recent ILCA conference where there was a
session on illicit drugs and breastfeeding which gave some
guidelines of how long to wait (or pump and dump) after use before
it was considered "safe".  The tape of this session could be a good
resource for Tammy.
Winnie Mading, RNC, IBCLC

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