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A year-old man who was a heroin addict developed bilateral, symmetrical swelling of the breasts as a result of injecting himself directly into the breasts for several years. Results of histologic examination of the breast tissue showed granulomatous inflammation and a foreign body reaction without gynecomastia or tumor. Liver and endocrine functions were generally normal. Arch Intern Med. X Facebook LinkedIn. This Issue. March Robert H. Rivlin, MD. Access through your institution. Add or change institution. Save Preferences. Privacy Policy Terms of Use. Access your subscriptions. Free access to newly published articles. Purchase access. Rent article Rent this article from DeepDyve. Sign in to access free PDF. Save your search. Customize your interests. Create a personal account or sign in to:. Privacy Policy. Make a comment.

Breastfeeding and Alcohol, Drugs, and Smoking

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Federal government websites often end in. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. NCBI Bookshelf. Heroin use during breastfeeding has not been systematically studied, but it has long been known that infants exposed via breastmilk can be affected and develop abstinence if breastmilk is discontinued. Heroin use by a nursing mother is generally considered to be a contraindication to breastfeeding. Mothers who discontinue heroin use and begin methadone, naltrexone or sublingual buprenorphine maintenance therapy should be encouraged to breastfeed with ongoing medical support. Heroin diamorphine by the intrathecal or epidural route is recommended for analgesia during cesarean section and for postoperative analgesia in the United Kingdom where a standardized pharmaceutical product is commercially available. Heroin diacetylmorphine is rapidly metabolized in the body to 6-monoacetylmorphine, which is about 6 times more potent than morphine; 6-monoacetylmorphine is further metabolized to morphine. All three drugs contribute to heroin's effects. Maternal Levels. The presence of morphine possibly indicated recent use of heroin. Infant Levels. A 2-month-old breastfed extent not stated infant whose mother admitted to using heroin two days prior was admitted to the hospital. The infant's stomach contents and blood were positive for opiates, but results were not quantified. A 1-month-old infant was brought to the emergency room with respiratory distress. Hair analysis of the parents and infant were all positive for morphine, codeine and the heroin metabolite 6-monoacetylmorphine as well as cocaine and its metabolite benzoylecgonine. The authors believed that the infant had been exposed to heroin and cocaine chronically via the placenta, breastmilk and inhalation of smoked heroin and cocaine. A paper from reported a breastfed newborn infant whose mother began using heroin as a snuff for abdominal pain. She continued to use the snuff and became dependent. Her breastfed extent not stated, but probably nearly exclusive infant slept excessively, but when awake would curl up with abdominal cramps and cry continuously until breastfed. When the mother was deprived of the drug, the infant would yawn, sneeze, sweat, cry and have cramps in addition to occasional diarrhea. The mother was arrested and the infant was examined by the prison physician. Upon examination, the infant was 'pale and flabby looking. The infant slept for most of the day then awoke with sweating and cramps. The infant was treated with camphorated tincture of opium paregoric and tincture of nux vomica containing strychnine three times daily. After 4 days of therapy, the infant reportedly appeared more cheerful and had no more cramps. A 2-month-old breastfed extent not stated infant presented to the hospital with irritability and a high-pitched cry. He developed hypertonia and opisthotonos and had an increased respiration and heart rate. Laboratory tests revealed a severe metabolic alkalosis. His mother admitted to using heroin 2 days prior to admission for the first time since delivery. The infant's stomach contents and blood were positive for opiates as was the breastmilk and urine of the mother. The infant developed bilateral pulmonary infiltrates and had two positive sweat tests, indicating cystic fibrosis. The authors attributed the infant's metabolic alkalosis to the profuse sweating from heroin withdrawal in the presence of undiagnosed cystic fibrosis. An 8-year-old girl was brought to a hospital in Iran by her aunt. The girl's mother had used heroin throughout pregnancy and lactation. She continued to breastfeed the child up to the time of admission to prevent heroin withdrawal. The girl had also not been enrolled in school to avoid signs of withdrawal in the child. Both mother and child were treated with buprenorphine for opiate dependence. Cyanosis, fixed and constricted pupils, muscular hypotony and respiratory failure were found on physical examination. Free and conjugated morphine and codeine were found in the infant's urine. Hair analysis of the infant was positive for morphine, codeine and 6-monoacetylmorphine as well as cocaine and its metabolite benzoylecgonine. The authors believed that the infant had been exposed to heroin and cocaine chronically via the placenta, breastmilk, and inhalation of smoked heroin and cocaine. Heroin and morphine can increase serum prolactin. One nursing mother was using heroin as a snuff and had an adequate milk supply. When she switched to using morphine by injection, her milk supply seemed to diminish and she needed to breastfeed more frequently. The amenorrhea-galactorrhea syndrome with 'copious galactorrhea' was reported in 3 heroin-dependent women in their early 20's. Serum prolactin was not measured, but all had hypoestrogenism and low gonadotropin levels. Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U. Attribution Statement: LactMed is a registered trademark of the U. Department of Health and Human Services. Turn recording back on. Help Accessibility Careers. Search term. Heroin Last Revision: June 15, Estimated reading time: 4 minutes. CASRN: Drug Levels and Effects Summary of Use during Lactation Heroin use during breastfeeding has not been systematically studied, but it has long been known that infants exposed via breastmilk can be affected and develop abstinence if breastmilk is discontinued. Drug Levels Heroin diacetylmorphine is rapidly metabolized in the body to 6-monoacetylmorphine, which is about 6 times more potent than morphine; 6-monoacetylmorphine is further metabolized to morphine. Effects in Breastfed Infants A paper from reported a breastfed newborn infant whose mother began using heroin as a snuff for abdominal pain. Effects on Lactation and Breastmilk Heroin and morphine can increase serum prolactin. References 1. Lichtenstein PM. Infant drug addicts. N Y Med J ; The effects of maternal narcotic addiction on the newborn. Am J Obstet Gynecol ; Breastfeeding: Neglect or excessive support? A case report of child abuse by a negligent heroin-dependent mother. Addict Health ; Academy of Breastfeeding Medicine Clinical Protocol Breastfeeding in the setting of substance use and substance use disorder Revised Breastfeed Med ; National Institute for Health and Clinical Excellence. Simultaneous analysis of frequently used licit and illicit psychoactive drugs in breast milk by liquid chromatography tandem mass spectrometry. J Pharm Biomed Anal ; Heroin withdrawal leads to metabolic alkalosis in an infant with cystic fibrosis. Eur J Pediatr ; Acute heroin intoxication in a baby chronically exposed to cocaine and heroin: A case report. J Med Case Rep ; Endocrine studies in heroin addicts. Psychoneuroendocrinology ; Prolactin and thyrotropin pituitary response to thyrotropin releasing hormone in young female heroin addicts. Drug Alcohol Depend ; Opiates, prolactin, and the dopamine receptor. J Clin Endocrinol Metab ; Galactorrhea-amenorrhea syndrome associated with heroin addiction. Substance Identification Substance Name Heroin. In this Page. Drug Levels and Effects Substance Identification. Bulk Download. LactMed Support Resources. Related information. Recent Activity. Clear Turn Off Turn On. Follow NCBI.

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