Can you take cocaine while breastfeeding?

How much cocaine gets into breastmilk

Cocaine is metabolized to benzoylecgonine which serves as a marker for cocaine ingestion. Other cocaine metabolites include ecgonine methyl ester and norcocaine. When cocaine and alcohol are taken together, cocaethylene is produced; its metabolite is ethylbenzoylecgonine. Both of these compounds are markers for concurrent use of cocaine and alcohol.

Maternal Levels. A woman reported using 500 mg of cocaine intranasally over a 4-hour period. Her milk contained about 10 to 15 mcg/L of cocaine 12 hours after ingestion that slowly decreased until 36 hours after the last use when it was unmeasurable. The benzoylecgonine concentration in her breastmilk was about 400 mcg/L at 12 hours after ingestion and dropped to undetectable levels by 36 hours post-ingestion.

Screening of breastmilk samples of 11 postpartum women who admitted to having used cocaine prepartum found primarily cocaine and benzoylecgonine in breastmilk of 6 of the women. Ecgonine methyl ester was usually not detected and only traces of norcocaine were detected unless cocaine concentrations were very high. One such subject had a concentration of 12.1 mg/L of cocaine, 4.1 mg/L of benzoylecgonine and 119 mg/L of ecgonine methyl ester in her breastmilk.

Ethylbenzoylecgonine has been found in the breastmilk of mothers who ingested cocaine and alcohol.

Breastmilk from a mother who admitted to cocaine use contained cocaine in a concentration of 5 mcg/L. The time of collection and amount of drug use was not stated.

Two women suspected of cocaine use prior to delivery had cocaine levels of 8 and 10.3 mcg/L in their colostrum. Benzoylecgonine (7.8 mcg/L) and the pyrolytic products anhydroecgonine methyl ester (9.5 mcg/L) and anhydroecgonine (9.8 mcg/L) were also detected in the mother with the higher cocaine level in colostrum. The pyrolytic products resulted from smoking crack cocaine.

A woman who admitted to 2 years of cocaine and cannabis use provided breastmilk sample 24 hours after delivery. She denied use of any drugs of abuse in the previous few days, although her urine was positive for cannabinoids and cocaine metabolites. Her breastmilk contained 138 mcg/L of cocaine. Neither norcocaine nor cocaethylene were detectable in breastmilk.

Single breastmilk samples were collected at a Brazilian hospital from 5 women who were suspected of abusing cocaine. Breastmilk cocaine concentrations ranged from 24.4 to 38.5 mcg/L with an average of 32.4 mcg/L. Benzoylecgonine concentrations ranged from 17.6 to 91.2 mcg/L with an average concentration of 53.5 mcg/L. The ratios of cocaine to benzoylecgonine varied, possibly related to the time of cocaine ingestion prior to breastmilk sampling. The milk of one woman contained no detectable cocaine or metabolite.

Infant Levels. A woman who was breastfeeding her 2-week-old daughter reported using about 500 mg of cocaine intranasally over a 4-hour period and breastfeeding 5 times during this period. The infant's urine contained cocaine in a concentration of about 100 mcg/L at 4 and 12 hours after the mother's last cocaine use; the concentration dropped to low levels by 24 hours, but was detectable up to 60 hours after the mother's last dose. The urine benzoylecgonine concentration was over 200 mcg/L at 4 hours post-ingestion and nearly 900 mcg/L at 12 hours post-ingestion. The benzoylecgonine concentration remained near 200 mcg/L until 60 hours post-ingestion when it was undetectable.

A 6-week-old, full-term, breastfed infant was found to have benzoylecgonine in his urine. The infant appeared to be normal but was small for his age. The infant's mother reported using cocaine throughout pregnancy and postpartum.

A retrospective study by a toxicology service in Italian hospital identified 11 of 124 infants admitted to the emergency department over a 7-year period in whom cocaine and/or benzoylecgonine were found in the urine. The investigators believed that the exposure was via either breastfeeding or inhalation of the smoke from crack cocaine used in proximity to the infant.

A 10-day-old infant was breastfed by a cocaine-addicted mother who reported inhaling 10 lines of cocaine 5 to 6 hours previously. A qualitative screening immunochromatography test (Abon) detected cocaine and metabolites (cut off >300 mcg/L) in urine and plasma samples from the baby.

What has been seen in breastfed infants

A woman who was breastfeeding her 1-week-old daughter reported using a "dab" of cocaine on her lower gum and nursing her infant with no effect on her infant's behavior or sleep pattern. One week later she used about 500 mg of cocaine intranasally over a 4-hour period and breastfed 5 times during this period. Three hours after first ingesting the cocaine, the mother noted that her infant became markedly irritable, had dilated pupils, and began vomiting and having diarrhea. The infant became increasingly irritable and was taken to the emergency room 4 hours later. On examination, the infant was found to be tremulous and irritable with frequent startling after minimal stimulation, and to have high-pitched crying, hyperactive reflexes, mood lability, and hypertension. The infant also had some signs of fetal alcohol syndrome. The infant remained irritable 12 hours after the last cocaine exposure and remained tremulous and easily startled 24 hours after the last exposure. Irritability and tremulousness slowly abated over the subsequent 24 hours. Mild hypertension persisted up to 72 hours after the last cocaine exposure via breastmilk.

The mother of an 11-day-old infant applied cocaine powder to her nipples for pain relief. She then breastfed her infant using a breast shield that allowed protrusion of her nipples. Three hours later, she found the infant gasping, choking and blue. On arrival at the emergency room, the infant was ashen and cyanotic. He had hypertension, tachycardia, shallow breathing, hypothermia and was in status epilepticus. Seizures resolved in a few hours after treatment and the infant was discharged at 16 days of age with no apparent sequelae. Although the infant's cocaine exposure was not via the drug in breastmilk, it illustrates the extreme risk of exposure of young infants to cocaine.

A one month and 3 day-old infant born at 36 weeks of gestation was brought to the emergency room with hypoactivity, sensory impairment and nose bleeding. The infant was afebrile, irritated, tearful, but with no signs of ventilatory effort or active bleeding. Tests showed leukocytosis, mild metabolic acidosis, increased serum glutamic-oxaloacetic transaminase and abnormal coagulation tests. Toxicological screening revealed cocaine in the infant’s plasma and the mother admitted to using cocaine and marijuana. The infant was reportedly breastfed, but the amount was not stated. During a 4-day hospitalization, the patient had two seizures, with movements of the upper limbs and oxygen desaturation. The authors attributed the infant’s symptoms to cocaine withdrawal.

A 10-day-old infant was breastfed by a cocaine-addicted mother who reported inhaling 6 lines of cocaine over the 5.5 to 11.5 hours prior to breastfeeding. The infant presented to the emergency department with cyanosis, abundant sialorrhea, and no clinical response with stimulation. In addition to finding cocaine in the infant’s blood, the activated partial thromboplastin time (aPTT ) was greater than the upper limit of normal (32 seconds) at 52.5 seconds. The infant was discharged 8 days later. The authors proposed a mechanism whereby cocaine could affect the infant’s aPTT.

A retrospective observational study reviewed children aged 0 to 10 years with suspected or confirmed cocaine exposure reported to French Poison Centers from January 1, 2020, to December 31, 2024. To be included, infants had to have a positive analytical toxicology result in urine screening performed by hospital-affiliated clinical or forensic laboratory. Twelve infants were exposed via breastfeeding; 10 were under 1 month of age, one was between 1 and 2 months and one was between 1 and 3 years of age. One fatal case (PSS 4) involved a 3-month-old male infant found dead at home; postmortem blood analysis confirmed the presence of cocaine. The child was found dead in his bed after breastfeeding from his mother, a cocaine user. While the cocaine levels were considered too low to have caused the death, the parents refused the autopsy. Toxicological screening revealed no other substances. In one case, an 11-day-old female infant, exclusively breastfed, presented with respiratory distress, muscular hypertonia, jaundice, and cardiac arrest upon emergency service arrival. Hair analysis revealed a cocaine concentration of 24.289 ng/mg; urinary cocaine was 52.5 mcg/L, suggesting both prenatal and breastfeeding exposure. The patient required resuscitation at home. No other substances were detected in the blood screening. A second fatal case involved a 3-month-old male infant found dead at home; postmortem blood analysis confirmed the presence of cocaine. The child was found dead in his bed after breastfeeding from his mother, a cocaine user. While the cocaine levels were considered too low to have caused the death, the parents refused the autopsy. Toxicological screening revealed no other substances.

Effects on milk supply

Long-term cocaine use can result in chronic, low-level hyperprolactinemia. The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

Mothers who use cocaine initiate breastfeeding of their infants less frequently than mothers who do not use cocaine.