Heroin and Nursing

[Monchhichi]

Hello,

I was on Subutex for the last twenty weeks of pregnancy. I was a recovering heroin addict in a methadone program when I learned of the pregnancy. I lost my job shortly after this and could no longer afford daily trips to the clinic. I was able to wean myself off the Subutex five days before delivery so the baby didn't appear to suffer any NAS in the hospital.

I have noticed since we came home after a two day stay, she wants to nurse constantly. She will cry a lot until someone (usually me) picks her up. If I nurse, she's fine. My question is; what is the data, if any, on transfer rates of insufflated heroin into milk? I relapsed twice and am awaiting Subutex induction next week. I am not an IV user nor do I use high amounts. I just wonder if she is experiencing prolonged withdrawal from whatever was left over from my subutex usr.

Thanks.

[admin-james]

Hi, thanks for your post.

Subutex (buprenorphine) has a half-life of 24-30 hours and only around 1% of it transfers into milk. The chances of your baby being exposed to any relevant amount of this medication through the breastmilk after a week of abstinence are practically zero. We give this medication a safety rating of 2 (out of 5, with 5 being the most dangerous) when used as prescribed in a woman who is exclusively breastfeeding.

The half-life of heroin is about 2 hours and it does not "hang around" in the tissues the way that marijuana does. However, a considerable amount transfers into the milk. This represents a very real threat to the baby if you nurse within a few hours of taking a large heroin dose.

If you have not used heroin or Subutex since delivery, then your baby is probably not suffering active withdrawal symptoms, nor is she being exposed to residual drug in your milk.

Please call us at the InfantRisk Center if this has not completely answered your question.*(806)352-2519

-James Abbey, MD
and
-Thomas W. Hale, Ph.D.

The following references may be useful to your physician if he or she needs more information: