Opiatabhängigkeit und Stillen : Literaturübersicht und Empfehlungen

Weaning in opiate addicted mothers remains a matter of debate. As methadone is the substance of choice in the treatment of opiate addiction in pregnancy, various studies have been conducted to evaluate its potential risk for the breastfed neonate. Reviewing the current literature we came to the conclusion that study results are not sufficient to recommend general weaning in women under opiate maintenance treatment. Although the numbers of cases investigated are small, the concentration of methadone or alternative opiates in breast milk or the infant's plasma seems to be neglible. Prior recommendations to promote breastfeeding only in mothers treated with lower methadone doses have had to be retracted. There is now evidence that methadone metabolism differs individually and a correlation between methadone dosage and maternal plasma concentrations has not been confirmed. Nevertheless polytoxic behaviour with consumption of various toxic substances has to be taken into consideration and likewise the high infection rate with HIV in the opiate addicted patient. In these cases weaning should be recommended.