When is it safe to resume breastfeeding after smoking marijuana?
I had 3 puffs of marijuana for Christmas. I now realize I have abruptly broken a bond and have taken the most valuable thing I could give her away.
I've done some research on THC and breastmilk: one-time use leaves minute amounts of THC. Small to minimal amounts may pass. I haven't breastfed her since and would like to know if I could resume now without risking any health issues for her?
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M$10 Answers
May I also recommend fish oil supplements while you're breastfeeding as some claim that it raises a childs IQ.
Good luck.
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M$
A good article from Canadian Family Physician says...
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QUESTION One of my breastfeeding patients is using marijuana to combat chronic pain. Is it safe for her to breastfeed?
ANSWER Lactating mothers should refrain from consuming cannabinoids. Advising mothers to discontinue breastfeeding if they cannot stop using cannabinoids must incorporate the known risks of formula feeding. Cannabinoid exposure through milk has not been shown to increase neonatal risk, but there are no appropriate studies of this. In every case, nursing babies should be closely monitored.
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There is much more well cited information here - http://www.cfpc.ca/cfp/2005/Mar/vol51-mar-clinical-1.asp
Mainly it only becomes a problem in the child during "heavy use"
The National Institute of Health refers to the same document on the topic. So I think you are OK... just no more smoking ok...? until you're done breastfeeding.
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M$
"While the use of marijuana can decrease milk supply, and produce sedation and growth delays when used in large doses, there have not been reports of health problems in babies that were caused solely by use of marijuana and breastfeeding. Due to inconclusive reports, the current recommendations for mothers who smoke marijuana are very similar to those regarding smoking cigarettes - continue to breastfeed and cut down on the amount smoked and do NOT expose babies to second-hand smoke."
Since you have already done the smoking (and not much at that) the proven benefits of breastfeeding certainly trump hypothetical danger. But I for one think you should try not to do it again unless it is proven safe.
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M$Three kids, 6 4 and 2 so still well in the "confer with the pediatrician regularly" stages.
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M$
Eatthatpopcorn, I'd disagree that "obviously" they know that. It's more likely the case that while she knows it, maybe she doesn't want to admit it. After all, she's asking a question about the health of her child to a bunch of anonymous strangers on the net. And her answer does not say "After I did it I immediately spoke to my pediatrician who said .... but I wanted to get other opinions."
I did not offer my own opinion, nor cite sources, precisely because I'm not a doctor and I would not know a reputable source from a disreputable one. And even if I could find a reputable source for my opinion that does not discount the possibility that someone else could find an equally reputable source for an argument against.
In short, there is no right or wrong answer to the question, at least not provably so, so the best the original asker can do is figure out whose opinion she trusts, and then follow it.
you're getting annoying jason
obviously they know they should consult a professional
This is a better answer because you are directing the person to a medical professional. This is the first thing ANYONE should say when answering a medical question like this: consult a professional.
The second thing should be "here are some articles and facts I found at the following sources which are considered by most to be reputable."
The final thing could be some personal opinion, but with the disclaimer you are NOT a doctor.
Jason's right. Responsible answerers on other Q&A sites do make a point of stating whether or not they have any professional qualifications and directing you to a professional when answering questions regarding money/taxes or medicine/health. The phrase "I'm a doctor, but I'm not your doctor." is often used.
I would also like to see more citations of research or studies in answers here, where available. I personally won't be giving a best answer to anyone who doesn't include such.
The other thing I wanted to find out for you was how much thc you actually get in your system from a few puffs of marijuana. A book resource off google says one puff of marijuana (for infrequent/first-time users) gives you about 7 to 20 ng/ML in your bloodstream. This can be enough to cause impairment, although the main impairment effect lasts for about 5 hours. It also gives information about the effects, how long they last, and about toxicity. It's pretty technical so may be hard to figure out. Also says the "half life" of marijuana is 28 hours for first-time users and 56 hours for chronic users. You're at almost 200 hours at this point.
So, using the max calculations here
3 puffs at 20 ng/mL = 60 ng/mL
168 hrs = between 3 and 4 half lifes
Which means you're at, minimum, around 3-4 ng/ML
And these are the stats for chronic users. If you've never done marijuana before, or are a very rare user, you metabolize faster.
I used the frequent user calcs for you because they give a worst-case situation of what the upper level might be in your system. And, one final thing, everyone's body is different, so there's some variation there even within the calcs I provided.
Although these calculations are rough at best, and I'm not a doctor, they show that you are probably OK to resume breast feeding now, but to be on the safe side you may want to wait a few days after New Year's.
So it was very smart of you to wait on breastfeeding for a while. You are a very considerate and thoughtful mother to think about something like this. Babies are so much tinier th an us, and even small amounts of drugs can affect them negatively. I know that certain cold medicines, especially ones with codeine, can be dangerous to take while breastfeeding because they can be passed through in breast milk.
Just don't worry, and use this as a lesson to keep yourself healthy and drug-free for the future.
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M$
This is a better answer, but I'm a little concerned about giving direct advice if you're not a doctor. Also, I'm not certain that a site called "marijuanapassion" is the most objective.
In all cases related to health it is important to state, up front, that a person should talk to a professional and NOT take action based upon what they learn on the web. They should use the web as a resource to find information and then bring it to a professional to discuss it.
The best combination for health is in my mind combining research, a knowledge exchange like Mahalo Answers and a professional like a doctor.
Overall I'm happier with the communities performance on this question but we still have a long way to go. Remember to do the following on every health question:
1. Tell the person to see a professional.
2. Tell the person you qualifications--or lack of qualifications.
3. Researcher your answer at trusted sites.
4. Use citations for any information you quote.
5. Encourage the user to take this information to a professional to discuss it further.
The "please ask your doctor" statement should be there as a CYA for Mahalo, but no one really pays attention to it. Just by the question, they're saying that they're going to listen to the answer they get, qualified, researched, or not. I agree that not giving a answer at all is worse because the asker probably won't go see a professional anyways and thus will listen to a couple friends instead of the impartial(to her) collective wisdom here, but anyone who answers the question needs to understand the responsibility they have to give an answer that corresponds as closely to reality as they possibly can. Most people should be actively discouraged from answering these question, and askers should probably be discouraged, too.
Carriep's answer, well-researched as it was, is still not good enough because even if it's true that the breastfeeder has 3-4 ng/mL cannabinoids in their bloodstream, you still don't know what percentage gets into the breastmilk, and what level a child is susceptible to, if at all.
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M$
This is not a good answer as it does not quote specific research and does not include citations. Please make an effort to find specific studies or articles from reputable publications when answering questions like this.
I got interrupted before I was done, and then opened the wrong tab and missed the edit window.
Here is an exerpt from a health journal:
"Infants exposed to marijuana via breast
milk will test positive in urine screens
for long periods (2-3 weeks). Long-term
effects of marijuana exposure through
breast milk are unknown.
Breast milk is the best food for babies.
It contains appropriate amounts of carbohydrates,
proteins, fats, minerals, vitamins,
and hormones as well as maternal
antibodies. Psychologically, breastfeeding
facilitates bonding between mother and
child. Advising mothers to discontinue
breastfeeding if they cannot stop using
cannabinoids must include warnings
about the known risks of formula feeding.
Referral to appropriate services for counseling
may be effi cacious." http://www.healthunit.org/reportpub/phy_news/2006/nexus_oct2006.pdf#page=6
And another, which also backs me up:
"QUESTION
One of my breastfeeding patients is using marijuana to combat chronic pain. Is it safe for her to breastfeed?
ANSWER
Lactating mothers should refrain from consuming cannabinoids. Advising mothers to discontinue breastfeeding if they cannot stop using cannabinoids must incorporate the known risks of formula feeding. Cannabinoid exposure through milk has not been shown to increase neonatal risk, but there are no appropriate studies of this. In every case, nursing babies should be closely monitored."--Can Fam Physician. 2005 March 10; 51(3): 349–350.
PMCID: PMC1472960
Copyright © 2005, Can Fam Physician
In this case, we're talking 3 puffs, immediately after which she has not nursed the baby in a week. According to the first link, she could have the baby's urine tested, or her own, to see if the cannabis is now out of both of their systems. That would be safest. And it would involve seeing a medical professional. Although, given the mandate all physicians now have to report child abuse/neglect (although some would see a case like this as a slip and not ongoing abuse), and the lack of research as to how long it takes to get out of the system and how much would have an effect on a newborn, I still would be a little hesitant about just how much good it would do. Whereas I know the antibodies and nutrients in breastmilk will do the baby a lot of good.
Breastfed 3 kids off an on for a decade (NOT continuously!) in all kinds of situations, not including drug use.
I searched for "breastfeeding marijuana" at pubmed.com, a database of biomedical literature. I got 14 results, 2 of which directly referenced marijuana and breastfeeding in the title. One of those articles is publicly available here: http://www.ncbi.nlm.nih.gov/pubmed/15794018 If you'd like a copy of the non-publicly available articles(which your tax money most likely paid for), you can post a request here:http://friendfeed.com/rooms/references-wanted or send me a message through this site,
The answer, in summary, is "we don't know, so you probably shouldn't."
"Lactating mothers should refrain from consuming cannabinoids. Advising mothers to discontinue breastfeeding if they cannot stop using cannabinoids must incorporate the known risks of formula feeding. Cannabinoid exposure through milk has not been shown to increase neonatal risk, but there are no appropriate studies of this. In every case, nursing babies should be closely monitored."
The study also says that 0.8% of the mothers dose per kilogram is passed to the infant.
If you're going to smoke anyways, at least pump your breast milk before smoking, and then before resuming feeding, pump your breast milk, then dump it, so you're not feeding breast milk which has accumulated cannabinoids. The Mayo clinic has a page on pumping: http://mayoclinic.com/health/breast-feeding/FL00120
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M$
Carrie, please don't do that. I think you made a very sincere effort, and there's no doubt that you added value to the set of answers here. The only place where you could get into trouble is by making too many assumptions, in an honest attempt to take an informed position, but in an area where you may be a little shaky.
Thanks for the clarification, Carrie. I understand your point about wanting to give some kind of answer rather than nothing, and I agree with that approach, since they wouldn't be asking here if they were willing or able to ask a professional. As I said above, I think they're going to get better information from our collective wisdom than from the presumed other method they'd use to get an answer, asking a couple friends.
The actual answer to the question, according to the studies that have been done on infant exposure to drugs via breast milk(which I pasted a link to above but it didn't become a hyperlink), is "we don't know." No amount of speculation by us is going to get closer to the truth if the experts haven't taken a position on this.
So we both speculated, assuming that speculation was better than nothing. The only concern with your careful answer, I think was that you missed the fact that studies actually have been done on this, because, sadly, pregnant women have taken various drugs. Studying these cases is how they arrived at the 0.8% of the mothers dose/kg ends up in breast milk number, and these studies were fairly easy to dig up. You'd have seen it if you searched pubmed. You also state that you don't think it's possible for a substance to accumulate to higher levels in breast milk than in blood. That's not a statement for which you'd find much clinical support, and in fact, I would assume the other way around. There are some studies on DDT exposure via milk in the developing world, which seem to support bioaccumulation. http://www.ncbi.nlm.nih.gov/pubmed/18049925
Searching the primary literature should be the bare minimum effort for a question like this, especially if you're going to speculate and give your best guess. That's my only concern with your otherwise helpful answer. Even to make the right assumptions in the first place sometimes takes a certain level of knowledge.
Let me address one of the major concerns about my answer, as well as a few others.
The second link to my answer was supposed to be to a Google archived site which is detailed clinical information. This was a proofreading error on my part, and I should have made sure that the proper link for source reference was provided. That link is here:
http://books.google.com/books?id=0Bw2UJTC_uMC&pg=PA907&dq=thc+in+one+puff+of+marijuana
This is my oversight and I apologize for this. The primary research for my answer was from the above link.
Second, I agree that, in addition to the disclaimer that is provided on health questions, that I should have said 'talk to your doctor.' This is always a good suggestion, and I'm sorry I overlooked it in this case. I will keep in mind all suggestions in comments, and incorporate them into my answers.
However, I think that there must be a point where it is safe for the mother to resume using breast milk to feed her child, eventually. That is what I was striving to find in my answer because that is what was asked. Because the asker smoked one joint a week ago shouldn't prevent her from breastfeeding her child ever again.
As far as I can surmise from the question that was asked, the asker was not a routine user of marijuana, and this was a one-time thing. This is not certain, and I stated in my answer that a lot of my calculations depended on how regular a user the asker was. I also used calculations for a "regular user."
To my analysis, this was not a regular user. It was someone who decided to try something new during the holidays and then thought better of it.
I made it very clear in my answer that the asker's frequency of use would come into play in this situation.
It does no good, IMHO, to demonize the mother in this situation. We all make mistakes. In fact, the mother has decided not to breastfeed in this situation because of the 3 puffs of marijuana a week ago.
The commenter who states that the asker should just pump before ingesting marijuana is correct, if the asker is a regular user of pot. But the question reads like a one-time lapse of judgment, and the asker has already realized it was a mistake, and decided not to repeat it. If the asker was a regular pot user, I'd say yes, pump before you toke.
I'll also point out that, although I did not say "ask a doctor," I encouraged the asker to err on the side of caution here.
In fact, "shakspearegeek" was the only one to say "ask a doctor" in the answer. Thanks,Shakespeargeek.
I chose to focus on what I did because I felt that the asker was best served by answering the question based on the assumptions laid out instead of getting down on her for making a mistake.
One last thing, that may be opening a can of worms. There is a legitimate concern here that, if the asker/mother tells her primary care physician the full situation, that it could have disastrous effects for the mother.
See following link for examples.
http://www.advocatesforpregnantwomen.org/issues/punishment_of_pregnant_women/
Again, we have to go with what the asker provides us. Frankly, we really don't have enough information to provide a good answer. We need to know 1. Mother's previous drug use habits, 2. Mother's relationship with OB/GYN and numerous other things to properly advise.
Since it's so complicated, yes, I can see more and more why saying "ask a doctor" is a prudent idea. These questions are tricky. Should they even be allowed on Mahalo Answers? is a legit question.
This type of question is, to a certain extent, skirting the line of what we do here in Mahalo Answers. When we answer and when we "punt" to a professional is always going to be a challenging ethical situation.
What it comes down to is, you are never going to get a study that determines how much dangerous substances are in breast milk. It is simply unethical to do so. All one can do is to determine the amount of substances in the mother's bloodstream, and extrapolate from there. If anyone believes that a fetus can get *more* of a substance from breast milk than the mother does, that it somehow becomes more concentrated, I'd like to see evidence on that, because I don't think that's possible.
I appreciate all the comments and feedback that my answer has engendered, and will make sure to keep all concerns and criticisms in mind in future questions. I'm here to help people, plain and simple. Don't care about the points when it comes down to it. All constructive criticism is appreciated, and every criticism was delivered with thought and care. So thanks for that.
Ok. Point taken. Pubmed is gold standard and I'll avoid most medical questions from here on out.
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M$You can leave an optional "tip" with Mahalo's virtual currency, Mahalo Dollars. If you are asking a difficult question that might require some research, or if you'd like a wide variety of feedback, a higher tip often leads to more answers to your question.
M$In the future, just don't puff!
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M$
Just a quick comment to point out two things that are strictly my opinion. I don't think anyone found on the QuackWatch website should be used as a resource for any serious researcher, and second, saying that something is "too addictive to ever be considered good" has no basis in reality. Just take the most used drug in the world: caffeine. It is highly addictive and can even produces withdrawal symptoms as well. However, it's benefits are well known and even promoted within some circles. Again, just my two cents' worth.
You obviously have not read anything by Dr. Amen.
"In our experience, the effects of smoking marijuana use typically cause decreased activity in the posterior temporal lobes bilaterally. The damage can be mild or severe, depending on how long a person used, how much use occurred, what other substances were used (nicotine is a powerful vasoconstrictor) and how vulnerable a particular brain is."
normal brain
http://www.amenclinics.com/_images/viewer/tn/NLUNDER.jpg
16 year old marijuana user
http://www.amenclinics.com/_images/viewer/tn/THCCOV.jpg
http://www.amenclinics.com/brain-science/spect-image-gallery/spect-atlas/images-of-alcohol-and-drug-abuse/
bmlhailstone, I like you, but you scare me sometimes. Somehow I don't think Marijuana will ever be promoted as a health "food." While I agree that it is not as bad as Cocaine or Meth, it is too addicting to ever be considered good.
The Fact refuted comment is inappropriate and uses a dubious source. It is not a refutation to simply disagree and find a source that supports you. You have to consider the weight of the preponderant studies and analysis. As a comment, it's reasonable to say this doctor disagrees, but it's a comment not a refutation. Especially when your source is a known quack.
http://www.quackwatch.org/06ResearchProjects/amen.html
Thanks for showing a little common sense and picking the best answer.
Cannabis is far less habit-forming than cigarettes, alcohol, cough syrup, or several other legal and very problematic drugs like vicodin or codeine. Not to mention that is has recently been shown in highly regarded studies to have many benefits, especially for those with cancer.
Check this article about how it slows the growth of cancerous tumors and can actually stop the growth in some situations: http://www.sciencedaily.com/releases/2007/04/070417193338.htm
And here's a story about how it doesn't raise your risk for lung cancer, which cigarettes do:
http://www.foxnews.com/story/0,2933,196678,00.html
It also reduces the tics and effects of Tourettes syndrome:
http://www.hc-sc.gc.ca/dhp-mps/marihuana/how-comment/medpract/infoprof/indications-eng.php
It helps cancer patients on chemotherapy develop an appetite, and also can be used to help bulimic and anorexic patients. And has been shown to help people with ADHD center their focus without the dangerous and addictive effects of Ritalin or other drugs.
The health benefits for the average citizen, while not as obvious, are numerous. There is no doubt that many people use the drug poorly and are prone to its depressive effects, which can cause many a lazy person. However, calling it a dangerous or addictive drug is absurd an accusation that I just can't stand for.
Mahalo for trying, however this is not a good answer as it does not quote specific research and does not include citations. Also, you don't state where you are getting your facts from--are you a doctor or researcher?
Thank God the user choose this as the best answer!
Although this has been resolved I just wanted to let you know that the only danger in breastfeeding while smoking pot is that social services could take your child away.
I grew up on a commune with hundreds and hundreds of people where both breastfeeding and smoking pot were practically religous. Pregnant and new mothers were at the top of the list for pot distribution rations.
All the children that I grew up with who breastfed from pot smoking mothers are all brilliant beyond the norm.
Most of us were honor roll students excelling in all areas, mentally and physically.
Many of us skipped grades.
Many of us, when in high school, were sought after by the top colleges in the country.
If there had been a study done on this subject, this commune would have been the place (several other large studies were done there in the 70's such as children raised on vegan diets (which proved that kids raised vegan are perfectly healthy)).
The only unhealthy thing you did to your child in your situation was to withhold your breastmilk.
There are places in India where they feed ganja balls to their kids and I have no doubt their kids are just fine, maybe even better than fine.
I do not admit to smoking pot while breastfeeding but both my children are genius and could read and write before attending school. Now they are both in the gifted classes and all their teachers are in total awe and amazment at how smart they are. They are both still in grade school and are smarter than most adults. My 3rd grader can do triple diget multiplication in his head. My older one is a walking encyclopedia and could regocnize and name every dinosour when he was only 2 telling everyone he wanted to be a palentologist when he grew up.
I tend to agree with Albanian. I recognize that you were refuting my fact, so I'm not getting on you there. But I wouldn't trust much of the garbage that an anti-cannabis doctor like Dr. Amen is spreading. These doctors are against the use of any drug, and don't recognize that cannabis should not be among them, even though plenty of medical studies have proven that cannabis is, in fact, very good for most individuals(not just those in pain) and has significant health benefits.
As an additional note, I have a friend who got doctor's approval to smoke marijuana during pregnancy. Her baby was born perfectly healthy and has no developmental issues to speak of. There will be a day when people stop looking at marijuana as a narcotic drug and see its benefits.
While you may not agree with my source, I did refute his comment.
Refute: rebut, overthrow by argument, evidence, or proof;
http://wordnetweb.princeton.edu/perl/webwn?s=refute
I use the "fact refute" button when I am disagreeing with the previous statement. That way, if someone scans the question, they will see which comments agree and which disagree. I know some people think I use this to gain points, but that's not the case. I don't really NEED anymore points, TYVM.