POLICY/PROCEDURE TITLE:
BREASTMILK: DRUGS OF ABUSE,
NARCOTICS AND USE OF HUMAN
MILK
WOMEN & INFANT SERVICES
RELATED TO:
ADMINISTRATIVE
CLINICAL
Medical Center Policy (MCP)
Nursing Practice Stds.
Effective date:
JCAHO
Patient Care Stds.
Unit/Department of Origin: ISCC, FMCC
QA
Other
Other Approval:
PAGE 1 OF _
Revision date:
Title 22
KEY ELEMENTS:
1.
2.
3.
4.
Drugs of abuse are known to have potential for risk to the young or premature infant
Infants gain benefit from early exposure to their mother’s milk
Most medications used by mothers result in very low levels of drug exposure in human milk
Straightforward unit policy will help to extend human milk benefits to all infants and clarify to mothers their
role in the health of their infant
5. Support of the mother/infant couplet at risk for substance abuse is a priority in our unit
POLICY STATEMENT:
1. All mothers will be asked about medication use in pregnancy
2. Mothers that use narcotics under a physicians order for chronic pain are, in general, allowed to breastfeed
3. Mothers with known or suspected street drug or alcohol use will be given the benefit of the doubt, educated
about providing safe milk for their infant, and followed closely
4. There is no need to discard milk, test the milk, or have the mother refrain from breastfeeding
RESPONSIBLE PARTY:
RN, NP, MD
PROCEDURE:
1. The pediatric medical team will review mother’s history, consult with pharmacy and standard tertiary
references (e.g. LactMed, Medications and Mother's Milk), to make an assessment of the breastfeeding
safety of a mother’s medications
2. Maternal chart will be reviewed for history of drug use, recent toxicology screening, and time of last positive
toxicology test
3. ISCC/FMCC social worker will evaluate mothers with a drug or alcohol history re: willingness to abstain
from substance abuse and to provide expressed breastmilk or breastfeed the infant
4. Mothers with known or suspected drug or alcohol history will be given handout on ‘Providing safe milk for
your baby
5. If mother agrees to abstain from street drug use (or to use only approved medications such as methadone),
her milk will be fed to her baby
6. Mothers who are taking prescribed narcotics will be given handout on ‘Providing Safe milk for your baby for
mothers on prescription medications’
7. If infant’s physician feels that an individual infant is at significant risk for toxicity from breastmilk, he/she
may order formula or donor human milk feedings in that child
Breastmilk Drugs of Abuse Narcotics.doc
02/17/16
UCSD Medical Center:
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8. A milk toxicology screen can be ordered if infant symptoms are believed to be resulting from potential
drugs or alcohol in mother’s milk
9. If CWS removes a child from the mother because of ongoing drug use, her breastmilk will no longer be
used for the infant
REFERENCES:
1
2
3
4
Transfer of drugs and other chemicals into human milk. Pediatrics 108, 776-789 (2001).
Jansson, L. M. ABM clinical protocol #21: Guidelines for breastfeeding and the drugdependent woman. Breastfeed Med 4, 225-228, doi:10.1089/bfm.2009.9987 (2009).
Bartu, A., Dusci, L. J. & Ilett, K. F. Transfer of methylamphetamine and amphetamine into
breast milk following recreational use of methylamphetamine. Br J Clin Pharmacol 67, 455459, doi:BCP3366 [pii] 10.1111/j.1365-2125.2009.03366.x (2009).
Jansson, L. M., Choo, R., Velez, M. L., Lowe, R. & Huestis, M. A. Methadone maintenance
and long-term lactation. Breastfeed Med 3, 34-37, doi:10.1089/bfm.2007.0032 (2008).
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