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 Post subject: bup/breast milk
PostPosted: Thu Dec 01, 2016 5:54 pm 
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I am currently on subutex and breastfeeding, I was on 4mg a day during pregnancy and baby was perfectly healthy with very low NAS scores and needed no medication for withdrawal symptoms. I already have a lower milk supply than most because I am on medication. I would greatly appreciate anyones experience with weaning from breast milk... when did you start weaning (how old was baby) and how did you do it? I have heard that the withdraw from the breast milk can be worse than at time of delivery... Please share experiences with me.


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 Post subject: Re: bup/breast milk
PostPosted: Thu Dec 01, 2016 10:07 pm 
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I write about neonatal abstinence syndrome here: http://suboxonetalkzone.com/babys-buprenorphine-withdrawal/

I've also posted articles about the amount of buprenorphine in breast milk, but I did a quick search and can't find the link. I'll post it if I find it.

The amount of buprenorphine in breast milk is very small. But the main issue isn't the low amount of breast milk, but rather the low bioavailabiliy of oral buprenorphine, even in newborns. Millions of years of evolution created safety system upon safety system, increasing the odds that generations with subtle improvements on prior generations will gain an advantage, and have a greater chance of surviving and bearing offspring. As a result, the first part of the intestine-- the part where nutrients and substances are first given an opportunity to gain entry into the body--- is perfused by the portal vein. The portal vein goes directly to the liver, so that anything swallowed that passes through the intestine goes to the liver first, before gaining access to the rest of the circulation.

Some substances are metabolized so efficiently that they are completely removed from the blood, on that first pass through the liver. The effect is called 'first pass metabolism', and is the reason why buprenorphine must be dosed through the oral mucosa or through the skin-- because if swallowed, it never reaches the other side of the liver.

In the uterus, the veins that perfuse the placenta go directly to the liver, but the immature liver is not as efficient. But by the time babies are born, the liver has the capacity to metabolize buprenorphine completely, as in adults. As a result, the small amount of buprenorphine in breast milk has little effect on babies. Yes, trace amounts of buprenorphine and buprenorphine metabolites will be found in babies of mothers on buprenorphine products who breastfeed. But there is not enough buprenorphine to create significant opioid effects in newborns.

I've posted a few times in the past week or two to encourage people to take a hard look at the things they hear about buprenorphine or Suboxone. There is so much incorrect information 'out there', and in many cases the incorrect information could easily lead to real harm. I encourage anyone who hears 'facts' about buprenorphine or Suboxone to question the data, and look beyond the headline or comment. if someone says 'withdrawal from breast milk is difficult', ask 'how do you know?' Was it studied? (I guarantee it wasn't, as a study looking at withdrawal from breast milk would be confounded by so many variables that no reputable scientific journal would publish the results). Was it based on a person's opinion? If so, how was the study done? What is the basis for the 'findings'-- i.e. why would withdrawal from breast milk be harder than any other withdrawal?

bfsubmom, please consider reading the link I posted above. There are some studies out there thay show traces of buprenorphine in breast milk, but little buprenorphine gets into the baby's circulation. I usually recommend that moms on buprenorphine breastfeed, just because in theory, any traces of buprenorphine will cushion any withdrawal that the baby may experience. But I doubt that breastfeeding has a significant effect on the chance of neonatal abstinence syndrome, other than providing comfort for the baby during nursing.

Good luck with your new baby!


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

  • Board Certified Psychiatrist
  • Asst Clinical Professor, Medical College of Wisconsin

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