Yes, opioids can be passed in breast milk. Some types of opioids (like Suboxone) are considered safer to take while breastfeeding than others (like some prescription painkillers).[1] Consult your doctor to ensure if medication you’re taking is safe for breastfeeding.
If you’re using illicit opioids like heroin or fentanyl, this is unsafe for babies, and you should seek addiction treatment. However, if you are taking an opioid for MAT (Medication for Addiction Treatment), either methadone or Suboxone, it is usually safe overall to continue to breastfeed your baby.
There are always small risks, but it is generally thought that the benefits of MAT outweigh those risks. Only minute amounts of MAT therapies like buprenorphine pass through to breast milk. The main risk is that these very small amounts could cause side effects in some babies, such as constipation, sleeping issues or feeding problems.[8] If you notice any of these signs in your baby, call your doctor promptly or visit an emergency room.
In most cases, breastfeeding can continue without any issues to the baby. Most providers encourage women to continue their MAT therapy while they breastfeed, particularly if they were on MAT during their pregnancy.
Opioid painkillers do pass through breast milk to a certain extent. If you are taking high doses or illicit opioids, this can cause life-threatening complications in babies including respiratory depression.[2] Using painkillers while breastfeeding can cause these issues in babies:[3]
Opioids come in many forms and the risks vary greatly depending on the type of opioid, and the dose. For example, it is never safe to use heroin or fentanyl while breastfeeding. However, if you are on an opioid based medication for OUD such as Suboxone or methadone, these medications may be safe to continue during breastfeeding.
MAT programs combine medications with therapy to help people stop using and misusing opioids. Buprenorphine-based medications like Suboxone are often used in MAT, and this medication is generally safe for a baby.
Studies show that babies don’t ingest and metabolize much buprenorphine from breast milk.[5] Researchers think that the drug isn’t bioavailable via breast milk, so it’s hard to pass the medication from a mom to her baby.[6]
Breastfeeding allows you to bond with your baby and take an active role as a parent. Caring for your baby could also encourage you to stick with your treatment plan and avoid relapsing to street drugs.[7]
The decision to continue Suboxone or methadone during breast feeding is complicated and individual. It may be safe and even recommended for some women. Other women may decide that they prefer not to take the risk and decide to formula feed instead.
There are a multitude of options. Talk openly with both your Suboxone/methadone provider as well as your obstetric provider about your options and what makes the most sense for you and your baby.
Illicit drugs like heroin are not safe to take in any amount while breastfeeding.[9] The body processes heroin into morphine, and this passes through to the baby via breast milk. This may result in babies having difficulty latching onto a bottle or breast, excessive sleepiness and breathing problems. It can even be fatal.
MAT therapies like buprenorphine and methadone don’t pass through breast milk in the same way, and they are less potent. While very tiny amounts of buprenorphine can pass into breast milk, most experts consider this amount to be so small that it won’t generally cause issues in babies.
This chart breaks down which opioids can potentially pass into to breast milk:[8,10]
Type of OpioidBreastfeeding EffectsPotential Effects on BabyHeroinPasses into breast milkLethargy, poor feeding, sleepiness, slowed breathing, vomiting, restlessness, dependence (leading to withdrawal), potential deathOxycodonePasses into breast milkConstipation, sleepiness, withdrawal if use stops suddenlyHydrocodonePasses into breast milkConstipation, sleepiness, withdrawal if use stops suddenlyCodeinePasses into breast milkConstipation, sleepiness, withdrawal if use stops suddenlyBuprenorphine (Suboxone)Passes into breast milk in very small amounts; use recommended to continue if part of OUD treatmentConstipation, sleepiness, withdrawal if use stops suddenlyMethadonePasses into breast milk in very small amounts; use recommended to continue if part of OUD treatmentConstipation, sleepiness, withdrawal if use stops suddenly
Can you breastfeed while taking opioids? It depends. Opioids come in many forms, both legal and illegal. Illegal substances like heroin and fentanyl are NEVER safe to take while breastfeeding. Conversely, opioid-based therapies like methadone and Suboxone do have some risks but generally are recommended to be continued, potentially even while breastfeeding. If you have specific questions about what opioids you can and cannot take while breastfeeding, talk to your addiction specialist and/or your obstetric provider.
If I choose not to breastfeed while on opioids, what are my other options? Breastfeeding does have some known benefits for both moms and babies. Breastfeeding helps with natural mother-child bonding, can help women lose weight postpartum, can provide added immunity to babies, etc. That being said, many women choose not to breastfeed while on methadone or Suboxone, which is totally reasonable. If you decide not to breastfeed, formula feeding is always an option if it makes more sense for you.
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
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