title: Maternal Buprenorphine Maintenance and Lactation.
abstract: BACKGROUND
  In addition to the well-known benefits of human milk and breastfeeding for the mother and infant, breastfeeding may mitigate neonatal abstinence syndrome severity in prenatally opioid-exposed infants. However, lack of conclusive data regarding the extent of the presence of buprenorphine and active metabolites in human milk makes the recommendation of breastfeeding for buprenorphine-maintained women difficult for many providers.
  
  
  OBJECTIVE
  This study seeks to determine the concentrations of buprenorphine and its active metabolites (norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide) in human milk, maternal plasma, and infant plasma of buprenorphine-maintained women and their infants.
  
  
  METHODS
  Up to 10 buprenorphine-maintained women provided paired breast milk and plasma samples at 2, 3, 4, 14, and 30 days postdelivery, and 9 infants provided plasma samples on day 14 of life. All samples were analyzed via liquid chromatography tandem mass spectrometry to determine concentrations of buprenorphine, norbuprenorphine, buprenorphine-glucuronide, and norbuprenorphine-glucuronide by a fully validated method.
  
  
  RESULTS
  Concentrations of buprenorphine and metabolites are low in human milk and maternal plasma. Breastfed infant plasma concentrations of buprenorphine were low or undetectable and metabolite concentrations undetectable at 14 days of infant age. There were significant correlations between maternal buprenorphine dose and maternal plasma and human milk buprenorphine concentrations.
  
  
  CONCLUSIONS
  These data find low concentrations of buprenorphine and metabolites in human milk and lend support to the recommendation for lactation among stable buprenorphine-maintained women. However, the correlation between maternal dose and maternal plasma and human milk buprenorphine concentrations bears further study.
authors: 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Lauren M
authors: LM
authors: Jansson
authors: 2 Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors: Nancy
authors: N
authors: Spencer
authors: 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Krystle
authors: K
authors: McConnell
authors: 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Martha
authors: M
authors: Velez
authors: 3 University of Maryland, Baltimore, MD, USA.
authors: Michelle
authors: M
authors: Tuten
authors: 2 Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
authors: Cheryl A
authors: CA
authors: Harrow
authors: 4 University of North Carolina, Chapel Hill, NC, USA.
authors: Hendrée E
authors: HE
authors: Jones
authors: 5 Clinical Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA.
authors: Madeleine J
authors: MJ
authors: Swortwood
authors: 5 Clinical Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA.
authors: Allan J
authors: AJ
authors: Barnes
authors: 5 Clinical Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, Intramural Research Program, National Institutes of Health, Bethesda, MD, USA.
authors: Karl B
authors: KB
authors: Scheidweiler
authors: 6 University of Maryland School of Medicine, Baltimore, MD, USA.
authors: Marilyn A
authors: MA
authors: Huestis
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D001942:Breast Feeding / Q000379:methods*; D002047:Buprenorphine / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007774:Lactation / Q000378:metabolism*; D008895:Milk, Human / Q000737:chemistry; D009035:Mothers / Q000523:psychology / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: breastfeeding; chemically dependent women; drug-exposed infants; substance abuse