Safely Supporting the Establishment of Breastfeeding in the Setting of Fentanyl Use Before the Birth Hospitalization

The authors aim to address the clinical challenges of supporting breastfeeding in families where nonprescribed fentanyl use occurs during pregnancy. They synthesize existing data on fentanyl's pharmacokinetics and its transmission into breast milk, proposing a harm-reduction approach that recommends initiating breastfeeding 72 hours after the last opioid use, coupled with parental treatment engagement and newborn monitoring. This guidance seeks to empower clinicians to provide compassionate support while ensuring safe breastfeeding practices in these complex situations.