Introduction
Psychedelics are becoming more normalized (and legalized) in our society: it’s undeniable. Here in Arizona, legislation has moved forward for the use of psychedelic mushrooms under controlled circumstances. Psychedelic-assisted therapy has become more and more common, with places like ketamine clinics opening up all around the country and even here in Tucson. Given the research coming out on how psychedelics can help with mental health and mood disorders, and the reduced stigma around using psychedelics, many parents are wondering what the potential risks are in regards to breastfeeding and chestfeeding. While research is still incredibly limited due to legal restrictions on studying psychedelics in general (and specifically with the pregnant, postpartum, breastfeeding and chestfeeding population), the available evidence can help in understanding how certain psychedelics may transfer into breast milk, to babies, and the potential effects on babies who ingest chest milk by someone who has used a psychedelic.
There are a couple clarifications I would like to make before diving into this subject. First, I would like to emphasize that there is very limited research on chestfeeding/breastfeeding and psychedelics. Further, for most psychedelics, there are no direct protocols on psychedelic use and breast/chest feeding. This blog post is a synthesis of relevant peer-reviewed research articles I have found. While the studies used may not all be directly studying psychedelics and breast milk, they are still science-based, relevant, and valuable overall. (My sources for information can be found at the end of this blog). The second point I would like to emphasize is that I am not advocating for the use of psychedelics. Rather, I am just presenting information on a subject that can often be hard to find given its “taboo” nature. I come from a public health background; I believe that people deserve to have reliable information in order to make their own informed decisions the same way they would with other substances like alcohol. Lastly, you may have noticed I am using terms like “breastfeeding”, “chestfeeding”, “breast milk”, and “chest milk”. I try to be as inclusive as possible and thus will be using these terms interchangeably throughout this post. For those who are unaware, many LGBT, non-binary, and queer parents use “chestfeeding” and “chest milk” to express (pun intended) when they are feeding a child via the chest with human-made milk.
Now that we got that out of the way, the psychedelic substances I will be reviewing here are: mushrooms (who’s psychedelic compounds are “psilocybin” and “psilocin”), ketamine (an anesthetic; aka “special K”), LSD (aka “acid”), and MDMA (aka “molly”).
Factors Influencing Drug Concentrations in Human Milk
Before getting into the specific substances themselves, I think it’s important we understand what factors actually influence the concentration of specific drugs in chest milk, as well as what factors influence the effect of the drugs on breastfed babies (next section). Please note that what I am about to list here applies to all substances including pharmaceuticals:
The concentration of the drug in blood plasma and how the drug is distributed throughout the body - plasma is the liquid part of blood (the other part are cells). Drugs mostly pass into breast milk via fats and liquids (this is known as “passive diffusion”). Drugs that distribute highly throughout the body will lessen the concentration in the plasma and thus will lower the concentration in chest milk.
The extent to which the drug binds to plasma proteins - drugs that are highly protein-bound (like ibuprofen) will minimally transfer into chest milk.
The size and weight of the drug molecule - smaller drug molecules like caffeine are more likely to enter breast milk.
pH of the drug - chest milk is more acidic (pH 7.2) than plasma (7.4). Thus drugs with higher acidity (lower pH #) enter more easily into breast milk.
Factors Influencing the Effects of Substances on Breast/Chest Fed Babies
Here, I am going to describe what factors influence the effects on babies who are breastfeeding/chestfeeding from a parent using psychedelics. As mentioned before, these factors apply to all drugs including pharmaceuticals:
Timing of when the drug is consumed vs when breastfeeding occurs - The longer the lapse of time is between drug use and breastfeeding, the less likely the baby is to ingest any of the drug.
The amount of chest milk the baby drinks from chestfeeding after the parent uses a drug, as well as the actual amount of the drug transferred to the infant via breastmilk (this is known as “relative infant dose” or “RID”. An RID of 10% or more is of concern).
Toxicity of the drug to the baby - Some drugs are more toxic to babies than others.
The age of the child - Studies show most issues with drugs in chest milk occur in babies under two months old and rarely in those over six months. A newborn’s metabolism and excretion ability is only at a third of what it is by seven to eight months of age. Also important to note is that babies exposed to a drug in-utero (just before delivery) and then breastfed will add to the drug concentration in the baby’s body.
Now that we’ve clarified what influences drug concentration in breastmilk, and what influences the effects of these drugs on babies who have been chestfed, let’s get into the specific substances themselves.
Psychedelic Mushrooms and Breast/Chest Milk
It appears that the production of breast milk is not affected by mushrooms. (It’s been found that during the peak effects of a mushroom experience, psilocybin can increase prolactin, the hormone responsible for producing chest milk. However, prolactin levels returned to normal about five hours after ingestion of the mushroom.) Evidence shows that almost all psilocin is eliminated from the body by 48-hours after ingestion of mushrooms.
So - Do psilocybin and psilocin pass through breast milk? Currently, the evidence is not clear. Psilocybin and psilocin potentially do not pass heavily into chest milk due to their acidic nature and because they bind to serum albumin, a plasma protein in the blood. (Potentially noteworthy is that serum albumin levels in chest milk are higher in the first three months postpartum.) However, psilocin molecules are light weight and lipophilic (meaning they attach to fats), which are two known factors to increase the likelihood of a substance passing into breast milk.
In one article by Jaraj and Rucker (2022), they write that in conducting future studies on psychedelics and breastfeeding, “Infant exposure and risk can be reduced by excluding breastfeeding women in the first 6 months postpartum, and advising women to abstain from breastfeeding for a 48-h period post-dose.” While this comment is in regards to scientific studies specifically, I do feel it is relevant to add here.
Overall, more research is needed in order to figure out how much psilocin and psilocybin are transferred into breast milk (if any at all) and into breastfed babies.
Ketamine and Breast/Chest Milk
Given the legality and regular use of ketamine in clinical settings, we actually have a lot more direct information on this substance. Studies have shown that the amount of ketamine transferred into chest milk is very low. This is because ketamine highly diffuses throughout the body, is eliminated from the bloodstream quickly, and has a higher pH of 7.4. Further, the relative infant dose (“RID”, the amount of a drug an infant receives from ingesting breast milk) has been shown to be less than 1% (as a reminder, an RID of 10% or more is of concern).
With ketamine, we actually have a little clearer guidance as far as breastfeeding goes. The “Guideline on Anaesthesia and Sedation in Breastfeeding Women 2020”, published by the Association of Anaesthetists of Great Britain and Ireland, states:
“Drugs used during anesthesia and after surgery pass in low levels into milk and women can breastfeed as normal after… ketamine”.
Other studies state that after a ketamine dose, chestfeeding is likely safe to resume as long as the parent feels awake, alert, and is able to hold their baby. This advice is similar to advice given after other anesthetics have been administered to a chestfeeding parent.
Breast/Chest Milk, MDMA, and LSD
While I could not find direct information on LSD and MDMA in regard to breast/chest feeding, one study did note that the frequent use of LSD and MDMA could have detrimental effects on the growth of the microbiota present in breast milk. This is important given that the microbiota in chest milk is a big part of what makes it nutritionally unique and ideal for babies; it cannot be replicated in other foods.
Research also shows that amphetamines, a substance very closely related to MDMA, tend to concentrate in breast milk. The National Institute of Health states “Amphetamine drugs (like MDMA) are found at higher levels in breastmilk than in the bloodstream. If MDMA has already been taken, it has been recommended to express and discard for 48 hours”
Conclusion and Resources
Given the ever changing legality of psychedelics in Arizona and across the United States, I expect more studies on psychedelics, breast milk, and chestfeeding will be published soon. With more accurate information, parents will be able to make their own decisions as to whether or not to use a psychedelic as a parent who breastfeeds. More importantly, better information will allow for chestfeeding guidelines to be made for parents who do decide to use a psychedelic.
Here are some Tucson-local and non-local resources on psychedelics. Many are mental-health specific. By the way, if you are interested in learning about psychedelics for postpartum mood disorders, check out my other blog post on the subject!:
Tucson Counseling Associates - Tucson Counseling Associates provides ketamine-assisted treatment as well as general psychotherapy.
Black Therapists Rock - A great resource for mental health in general but in particular for Black individuals who are often left out of the psychedelics conversation. This group is run by Deran Young, a therapist who was able to treat her own mental health through ketamine-assisted treatment. She gave an excellent talk on “reversing racial trauma through collective healing” during the Science of Psychedelics conference last year (2023) which was one of my favorites of the conference.
Moms on Mushrooms - While this page is specifically for mothers, this group “...bridges the gap between uncertainty and community by providing education and support, exclusively for mothers, through multiple offerings centered around the sacred practice of microdosing mushrooms.”
“How to Change Your Mind” by Michael Pollan - this is an excellent book on psychedelics. While it doesn't specifically focus on postpartum or parents, its unbiased account on the history and background of psychedelics is incredibly informative (and interesting; it will change the way you look at psychedelics).
References:
Jairaj, C. and Rucker, J.J. Postpartum Depression: A Role for Psychedelics? 2022; 36(8): 920-931. Journal of Psychopharmacology.
Mudjihartini, N. Comparison of Serum Albumin Levels in the Breastmilk of Breastfeeding Infants Aged 1-3 Months and 4-6 Months. 2023, 1(2). Indonesian Journal of Medical Chemistry and Bioinformatics.
Hotham N, Hotham E. Drugs in Breastfeeding. 2015 Oct;38(5):156-9. Australian Prescriber.
Mitchell, J., Jones, W., Winkley, E, & Kinsella, S.M. Guideline on anaesthesia and sedation in breastfeeding women 2020. 2020; 75:11:1482-1493. Association of Anaesthetists.
Majdinasab, E. ... & Hale, T.W. Pharmacokinetics of Ketamine Transfer Into Human Milk. 2023;43(5):407-410. J Clin Psychopharmacol.
Wolfson, P. ... & Whippo, M. The Pharmacokinetics of Ketamine in the Breast Milk of Lactating Women: Quantification of Ketamine and Metabolites. 2021;55(3):354-358. J of Psychoactive Drugs.
Dinis-Oliveira, R.J. Metabolism and Metabolomics of Ketamine: A Toxicological Approach. 2017;2(1):2-10. Forensic Sciences Research.
J.A. Amezcua Lopez, ... &Aguilar Uscanga, B.R. Effects of maternal toxic substance consumption during breastfeeding on lactic acid bacteria abundance and nutritional content. 2023;20(12):1513-1526. Int J of Medical Sciences.
NIH. MDMA (Molly, Ecstasy). 2022. https://www.ncbi.nlm.nih.gov/books/NBK582535/
Sachs, H.C. ... & Van den Anker, J. The Transfer of Drugs and Therapeutics Into Human Breast Milk: An Update on Selected Topics. 2013;132(3):796-809. American Academy of Pediatrics.
Chen-Li, D.... & McIntyre, R.S. Ketamine as potential treatment for postpartum depression: A narrative review. 2022; 34(4):264-274. Annals of Clinical Psychiatry: J. of the American Academy of Clinical Psychiatrists.
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