For 18 years (from September 1983 until September 2001), the American Academy of Pediatrics (AAP) recommended that methadone was only compatible with breastfeeding at maternal doses ≤20 mg per 24 hours.1–3  This effectively eliminated breastfeeding for the majority of US women on methadone maintenance therapy, because high doses are usually given in the third trimester to offset the apparent increase in methadone metabolism during pregnancy. In September 2001, with the release of the latest AAP statement, the dose restriction for methadone was eliminated, making methadone compatible with breastfeeding. With a national incidence of 1 to 3/1000, up to 120 000 newborns with neonatal abstinence syndrome (NAS) may be affected by this change. This new AAP recommendation requires us to reexamine our policies, create new guidelines for women on methadone maintenance who choose to breastfeed, and take a fresh look at our approach to the complex,...

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