Data indicates that as many as 10 to 15 percent of lactating parents use some kind of cannabis product while they are breastfeeding or chestfeeding.
Chances are, this includes some of the parents you care for.
When it comes to the safety of cannabis use during lactation, what do we really know for sure?
At the upcoming ILCA Conference 2021, Dr. Thomas Hale, Professor of Pediatrics, Assistant Dean of Research, and Director of the Clinical Research Unit at Texas Tech School of Medicine in Amarillo, Texas, USA, will address this important topic.
Hale has spent the last 20 years teaching pediatric drug therapy in pregnant and breastfeeding parents and is considered by most to be the world’s leading authority on the use of medications and human milk.
In this Q&A, Hale provides a preview of his upcoming talk—and shares thoughts on the critical importance of basing the cannabis discussion on kinetics, not hysteria.
Thirty-six states in the United States have legalized marijuana in some form. Are you getting more questions about its use in lactating parents?
Hale: Many, many hospitals are having discussions about this topic right now, and I get calls every week.
What do lactation professionals need to understand about cannabis use and human milk?
They need to know that right now, many of the suggestions and recommendations are based on hysteria, not reality.
When it comes to drugs in human milk, the real story about kinetics.
If a person has a positive urine test for marijuana, it tells you that there is a little bit in the urine. This does not tell you much of anything.
It’s like looking at the Mississippi River and seeing that a stone has been tossed in.
When someone smokes marijuana, it goes into the plasma compartment. It peaks in the plasma at about six to eight minutes. It troughs and is completely gone at about 22 minutes.
The vast majority of it goes to adipose tissue, where it resides for up to a month. It is inactive. It doesn’t do anything. It just leaks out a drop every now and then.
In low to moderate use, the levels that pass into the milk are exceedingly, exceedingly low.
The rest of the story is, when you take marijuana orally, as a baby would in breastmilk, only one to five percent is absorbed. Ninety-nine percent is picked up by the liver and never gets to the plasma.
What is real is that even if the baby nurses right after the parent smokes marijuana, the baby will get at very most 8.7 percent of the parent’s dose. And they will only absorb one percent of that.
What are the downsides of healthcare professionals not understanding the level of risk?
Recently, I was recruited to give a lecture about cannabis and other drugs and breastfeeding at a big NICU in the Northeast. The hospital had a policy that if you were drug-screened positive for marijuana, you could not breastfeed. The policy was causing disagreement among the doctors, the neonatologists, and the nursing staff.
The doctors, like me, realized that just because a mother drug-screens positive doesn’t mean there is a clinical amount in the milk. They also know that, with premature babies, if you breastfeed, you reduce the risk of necrotizing enterocolitis by fourteenfold.
The doctors said, “We know that we can save babies’ lives simply by giving them mom’s milk. We want to give them mom’s milk.”
But the policy said no.
If you were an IBCLC advising a client on the safety of marijuana use, what would you tell them?
I am not trying to promote its use.
I think what I would say is, it is not advisable to use it while you are breastfeeding at all. We do not know all of the long-term consequences.
But I am a pharmacologist. My work is based on reality: How much is absorbed by the parent, how much gets into breastmilk, and what is the dose to the baby?
Our data shows that five to 15 percent of breastfeeding mothers use cannabis. Seventy percent of those in our sample use it for an anxiety disorder, and others use it for chronic pain.
If a parent is told they cannot breastfeed and use cannabis, and they discontinue breastfeeding, that is a significant loss with big risks.
If you are working in a hospital setting with premature babies, it can be the difference between life and death.
It is a judgement call. If a mother uses it moderately, if she can wait a few hours afterward to breastfeed, the risks are relatively low.
What are your thoughts on the L-level of marijuana in the next edition of Hale’s Medications in Mother’s Milk?
Right now, it is an L4. I think I will probably drop it to an L3.
What will you and your team be sharing at the ILCA Conference?
Some of my crew will share much more about the data on marijuana, including new research we have done and more that is underway.
Another will present about breastfeeding and nutrition.
And, we are going to present something so brand new that no one even knows about it yet! It has to do with the endocannabinoid system and human milk. We have made a tremendously exciting new discovery and I am excited to unveil it at the conference.
It’s a wonderful area to be in. It’s really a lot of fun. I’m looking forward to showing you my whole team!
Learn more about Dr. Hale and his team and their role at #ILCA21 and the Infant Risk Symposium here.