Maternal substance abuse is not a categorical contraindication to breastfeeding.
Street drugs such as PCP (phencyclidine), cocaine, and cannabis can be detected in human milk, and their use by breastfeeding mothers is of concern, particularly regarding the infant's long-term neurobehavioral development and thus are contraindicated.
Although the 2012 recommendation has been interpreted by some professional organizations to indicate that in the parent using marijuana, the choice to breastfeed is "contraindicated," this was not the intent of that statement.
It is suggested instead that the mother be encouraged to breastfeed while, at the same time, it is strongly encouraged that she abstains completely from using marijuana as well as other drugs, alcohol, and tobacco.
Mothers should not breastfeed or feed expressed mil to their infants if they are using an illicit street drug, such as PCP (phencyclidine) or cocaine. (Exception: Narcotic-dependent mothers who are enrolled in a supervised medication-assisted treatment program and have a negative screening for HIV infection and other illicit drugs can breastfeed).
A woman with current or past history of substance use disorder should not be summarily excluded from or criminalized for nursing her infant. For women in well-supervised medication-assisted treatment programs, breastfeeding is encouraged. Obstetrician-gynecologists must have accurate information about the potential dangers of illicit substances and high concentrations of alcohol through breast milk so they can accurately advise patients about benefits and harms of breastfeeding.
