Opioids

Buprenorphine and methadone maintenance therapy are generally compatible with breastfeeding. Opioid users had the lowest breastfeeding continuation rate at 6 months. Cochrane reviews found methadone overall superior to buprenorphine for treatment retention, though efficacy differences are small. Some service users may find buprenorphine less satisfying than methadone because it has a weaker opioid effect. Buprenorphine was first introduced in France in 1995 primarily as a harm reduction measure. Methadone has been used for opioid dependence since the 1960s. Buprenorphine's ceiling effect reduces overdose risk by limiting additional euphoria or respiratory depression at higher doses. Methadone is a full opioid agonist with a long duration of action and is mainly administered as an oral liquid. Studies in healthy volunteers suggest morphine and other opioids may relieve the sensation of air hunger but not the distress caused by increased breathing effort. Codeine poses a pharmacogenomic breastfeeding risk for ultra-rapid CYP2D6 metabolisers. Maternal sedation, infant withdrawal symptoms, and stigma are drivers of low continuation among opioid users. Buprenorphine can displace full a…