The benefits of breastfeeding for the mother and infant are well known, however little is known about the safety of breastfeeding when new mothers are being treated with the medication buprenorphine to manage their addiction to opioids. It has been unclear how much buprenorphine is transmitted to the infant through breast milk, or if breastfeeding or breast milk might help relieve neonatal abstinence syndrome -- signs and symptoms of opioid withdrawal experienced by most opioid exposed babies. This leaves clinicians and their patients with the challenge of having to decide between a woman’s need to continue with medication assisted treatment and a baby’s need for breast milk.
Scientists from the National Institute on Drug Abuse (NIDA) sought to determine the concentrations of buprenorphine in human milk, maternal plasma, and infant plasma of buprenorphine-maintained women and their infants. Ten buprenorphine-maintained women provided paired breast milk and plasma samples at several points during the first month postdelivery. In addition, nine infants provided plasma samples on 14th day of life. All samples were analyzed via liquid chromatography tandem mass spectrometry to determine concentrations of buprenorphine and its metabolites (norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide).
Scientists learned that concentrations of buprenorphine and metabolites are low in human milk and maternal plasma. Breastfed infant plasma concentrations of buprenorphine were also low or undetectable at 14 days of infant age. Only one of the infants needed medication to treat neonatal abstinence syndrome. Findings support the recommendation for lactation among stable buprenorphine-maintained women. However, a correlation that was found between maternal medication dose and plasma and breast milk concentrations bears further study.