From the Families in Recovery (FIR) Unit, BC Women's Hospital and Health Centre, Vancouver, BC, Canada (CJP, IJG, SGo, NC, VP, KS); Women's Health Research Institute, Vancouver, BC, Canada (CJP, IJG, SGo, AA, KS, SGe); Department of Family Practice, University of British Columbia, Vancouver, BC, Canada (CJP); Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada (AA); Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada (SGe); and Department of Public Health and Social Policy, University of Victoria, Victoria, BC, Canada (KU).
J Addict Med. 2023;17(2):222-226. doi: 10.1097/ADM.0000000000001055. Epub 2022 Aug 24.
Injectable opioid agonist therapy (iOAT) is the highest-intensity treatment currently available in Canada for individuals with severe opioid use disorder. However, there is limited data on iOAT administration in the perinatal period, with no research, practice guidelines, or known reports of breastfeeding on iOAT. This article presents the first known case of an individual breastfeeding on iOAT.
We present a case of a pregnant 32-year-old woman from Canada with severe opioid use disorder, who stabilized with iOAT and chose to breastfeed her infant. She presented to hospital at 38 + 6 gestation in labor, unstable in her substance use disorder despite multiple interventions and was initiated on iOAT (intravenous hydromorphone) shortly after delivery. Before initiation of breastfeeding the infant was admitted to the neonatal intensive care unit for monitoring. On day 9 of life the infant received breastmilk for the first time, and was discharged from neonatal intensive care unit on day 12 of life with no clinical evidence of sedation or respiratory depression. The infant maintained mixed feeding and at 58 days of life was discharged in the mother and father's care, a healthy infant with stable vitals.
This case suggests positive infant and maternal health and social outcomes for breastfeeding on iOAT. Further research on perinatal iOAT use and the pharmacokinetics of high-dose hydromorphone in breastmilk is required to inform clinical practice guidelines to safely support individuals and their infants who are impacted by substance use.
注射用阿片类激动剂治疗（iOAT）是加拿大目前针对严重阿片类药物使用障碍患者提供的最强化治疗。然而，围产期 iOAT 管理的数据有限，没有关于 iOAT 期间母乳喂养的研究、实践指南或已知报告。本文介绍了首例已知在 iOAT 期间进行母乳喂养的病例。
我们介绍了一位来自加拿大的 32 岁患有严重阿片类药物使用障碍的孕妇的病例，她通过 iOAT 稳定下来并选择母乳喂养她的婴儿。她在 38+6 孕周分娩时入院，尽管进行了多次干预，但她的物质使用障碍仍不稳定，并在分娩后不久开始接受 iOAT（静脉注射氢吗啡酮）治疗。在开始母乳喂养之前，婴儿被送入新生儿重症监护病房进行监测。在出生后的第 9 天，婴儿第一次接受了母乳，在出生后的第 12 天，婴儿从新生儿重症监护病房出院，没有镇静或呼吸抑制的临床证据。婴儿维持混合喂养，在 58 天时，婴儿在母亲和父亲的照顾下出院，是一个健康的婴儿，生命体征稳定。
该病例表明在 iOAT 期间进行母乳喂养对婴儿和母亲的健康和社会结果均有积极影响。需要进一步研究围产期 iOAT 使用和高剂量氢吗啡酮在母乳中的药代动力学，以制定临床实践指南，为受物质使用影响的个人及其婴儿提供安全支持。
