LAUSR

Inequitable access to mother’s milk represents a social injustice with the potential to negatively impact the health and well-being of future generations (Jones, Power, Queenan, & Schulkin, 2015). Mother’s milk is globally accepted as the optimal source of infant nutrition, yet breastfeeding initiation and duration rates among minority populations (e.g., women with opioid use disorders [OUDs]) continue to lag those of the general population (Demirci, Bogen, & Klionsky, 2015). For example, 56% of women receiving medication-assisted treatment (MAT) for an OUD initiate breastfeeding (Schiff et al., 2018) compared to the national initiation rate of 82% (Centers for Disease Control and Prevention [CDC], 2017). Further, only 50% of mothers receiving MAT for an OUD who initiate breastfeeding continue beyond the first week of life (Demirci et al., 2015; Wachman, Byun, & Phillip, 2010). These numbers reflect some of the lowest breastfeeding rates in the United States (Demirci et al., 2015). Considering the current U.S. opioid crisis and its increasing influence on women of reproductive age (CDC, 2015), women with an OUD and their infants represent an emerging disparate population that may have inequitable access to breastfeeding and the benefits of mother’s milk. More than 50 years of evidence now exists to support the safety and benefits of MAT, particularly the use of methadone, during pregnancy and lactation (Sachs, 2013); however, a delay in the implementation of this evidence into clinical practice continues (McGlothen, Cleveland, & Gill, 2017). Therefore, this policy paper serves as a call for social justice with the intent of empowering lactation support providers to advocate for the use of scientific evidence that informs breastfeeding practices for women receiving MAT for an OUD. OUD is a serious global health concern (National Institute on Drug Abuse [NIDA], 2014) with an estimated 15 million people experiencing opioid dependence worldwide (Information Sheet on Opioid Overdose, 2014). As a result of the current U.S. opioid crisis, the rate of opioid use among American women has doubled since 2004 (NIDA, 2014) and has also had an influence on pregnant women and their infants. It is estimated that 21,000 pregnant, American women misuse opioids annually (Smith & Lipari, 2017). Prenatal opioid use can contribute to numerous pregnancy complications (e.g., placental abruption, preterm birth, and low birth weight) (Minozzi, Amato, Bellisario, Ferri, & Davoli, 2013). Medically supervised opioid detoxification during pregnancy is not recommended since it can contribute to high rates of maternal relapse into opioid use and risk for overdose due to the reduction in opioid tolerance that results from detoxification (American College of Obstetricians & Gynecologists [ACOG], 2017). Thus, stabilization of pregnant, opioid-dependent women, with the long-acting opioids methadone or buprenorphine, is considered the standard of care (ACOG, 2017). Further, pregnant opioid-dependent women who are stabilized on MAT tend to receive more consistent prenatal care, have better nutrition, and experience more positive pregnancy outcomes (Cleveland, Paradise, Borsuk, Courtois, & Ramirez, 2015; Jones et al., 2013). Although MAT during pregnancy is considered the standard of care for this population of women, neonatal abstinence syndrome (NAS) may still result from in utero exposure to medications used for MAT. NAS is a predictable 789401 JHLXXX10.1177/0890334418789401Journal of Human LactationMcGlothen and Cleveland research-article2018