Mahalo for trying, however this is not a good answer as it does not quote specific research and does not include citations.

Breastfed 3 kids off an on for a decade (NOT continuously!) in all kinds of situations, not including drug use.

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.

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.

you're getting annoying jason

obviously they know they should consult a professional

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.

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.

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.

That's a good start shareme, however a better answer would include some extra time spent on finding articles and studies from respected websites like WebMD or Mayoclinic and .gov sites.

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.

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.

Ok. Point taken. Pubmed is gold standard and I'll avoid most medical questions from here on out.

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.