It's now blog 4 of this series, clearly I'm fully committed to researching this stuff for y'all! I even went to a fantastic cannabis, trauma, oxytocin and breastfeeding webinar with Dr. Kathleen Kendall-Tackett recently hosted by the San Diego County Breastfeeding Coalition. It was extremely insightful and delightfully non-biased. I loved it! See I'm putting in work to keep up to date evidence based research in this space for my people. We don't gatekeep here, all the tea, all the time.
My health care provider friends often wonder, how I even get the truth of the situation from my clients. In order to know if a parent is using cannabis while breastfeeding, I establish a sufficient rapport and create a safe welcoming environment for parents to disclose their use to me. I then focus on harm reduction strategies, find out what supports are in place, and even work on safety planning. This is my personal approach to providing whole person centered care within lactation. Another question I ask myself is "When does risk of exposure to substance exceed risks of formula feeding?" This doesn't mean anti-formula, on the contrary, it means breastfeeding and cannabis might be the safer route vs. formula due to the protective factors of breastfeeding, and some would say cannabis, have on the parent and baby vs. the side effects of formula usage.
Recently, I had a breastfeeding client who is considered a heavy / daily user. She gave me permission to share this story...she knows about my Lit Tit blog & that I had recently went to a human milk research workshop. So she told me she decided to participate in a cannabis research study that she saw advertised on social media. I excitedly asked if she could share any details with me & she did! She asked for the results of her tested breastmilk and it concluded that there was not any detectable cannabis derived compounds in the sample. This result will not be the same from person to person. But Yay for her!
While this seems promising, more research still needs to be done to find compelling evidence to support our theory that you should still breastfeed if using cannabis, as the benefits of human milk outweigh the risks of cannabis consumption. If you would like to contribute to research keep reading for a resource, the UCSD Human Milk Institute.
A lot of women use cannabis during pre-conception and reproductive years for womb health and to mitigate symptoms associated with menstruation like PMDD and PMS. I also work with quite a few veteran military mom clients who use cannabis in conjunction with therapy for their diagnosed PTSD from combat, deployment and unfortunately on duty assaults. So, it's fair to say abstinence or quitting cannabis, especially for medicinal purpose users, is not always the easiest or most realistic solution. You may have a prescription for medical marijuana, or you may want to partake of marijuana edibles in states where it is now legal for recreational use at the state level.
However, since weed is still a federally illegal plant, it is beyond taboo to seek funding for research around something that is not legalized federally. Not to mention the fact that many parents, especially parents of color, don't want to contribute to research out of valid fears of having their child taken away. I've heard this happen to various people around the U.S. via comments on my TikTok. CPS threatens cannabis using parents in many states, even where legal.
Systematic racism takes the cake once again. The stigmatization of the substance is very real for parents who choose to use marijuana while nursing. Black and Brown folks are the most vulnerable, as we have been historically linked to punitive approaches, discriminatory practices and mistreatment related to use and possession of cannabis. This has had a resounding and disproportionate impact on us Black
Folx as a minority population. If we can't get reparations we should at least be able to explore and reconnect with our ancestral healing practices around indigenous plant medicine, including cannabis and it's medicinal qualities, without negative repercussions. Tobacco is doing far worse things to us as a society, but we aren't arresting folks for that, something known to be harmful to the health of the general public. For example, there was an old La Leche League rule that said 2 packs of cigarettes a day is still more helpful to breastfeed than not to breastfeed. However, compared to cannabis, there are a lots of risks associated with tobacco.
I love that the #cannamoms are using their voice to uplift others in the canna parenting community, but let's be real, most of these are well to do, white, cis gendered women in these spaces of sharing about their usage. Including my client who had her milk tested for research. She recognized her privilege to me.
I've had the pleasure of supporting many folks who come to me in confidence for support when other lactation consultants or medical professionals have wrote them off after disclosing use or having a positive result of use. They know that I don't judge, and that all I want is for lactating parents to be able to make informed decisions without guilt or shame.
My role in cannabis and parenting advocacy is to help families make informed choices by providing them with resources to trusted physicians and healthcare providers, as well as helping them understand the differences in cannabis consumption between methods and even the safety of cannabis products. I strive to help families navigate this unjust system to avoid being criminalized. I also educate on the ways to lower the risk of exposure for baby and hopefully take away any guilt you have with your self care practices of choice.
Short on time? Jump to what you wanna learn:
If you've been around here for a while, or have read volumes 1 - 3 of the Lit Tit blog series, you already know that I've laid out the information and evidence that say there is no black and white answer to cannabis use while nursing. It's still very gray & foggy, but many researchers like the UCSD Human Milk Institute, are working to change that!
Here's what we DO know:
We know THC crosses into the milk.
We know that the amount has been minuscule to small in quantity.
We know THC has a long half life and stores in our fat--We know our breast tissues have a lot of fat.
We know that cannabis can be helpful for many ailments, chronic conditions, mental health and reproductive issues.
We know that the benefits of human milk for baby outweigh the risk of cannabis exposure from lactating parent
We know that secondhand smoke of any kind is harmful
We don't know what type of long term effects cannabis use during breastfeeding might have on infant and child development., but research is being done.
Methods of Consumption
There have been limited studies and research on breastfeeding and cannabis use. The ones that have been done focused on inhalation or smoking of cannabis.
However, we know that nowadays, people consume cannabis in a variety of ways. Some view cannabis as a superfood of sorts, so they consume edibles. Some don't like smoking or food edibles, and prefer to use it as a tincture, oil or topical.
Then there are the many types of smoking apparatuses--joint, blunt, bong, bubbler, pipe (short/long), etc...You get the point, there are a ton of ways to consume cannabis and for this reason we must discuss how these methods individually work in the body and in regards to how they go into the milk.
But is there one way that may be considered less harmful or create less exposure than another?
A quick overview of these methods:
Inhalation/Smoke - This method last the least amount of time in the system, the high is the shortest and the onset is the fastest. With smoking, THC can be detected in the bloodstream within seconds of an inhale. That's why you get that "this sh*t hittin' good" feeling almost immediately after your puff. THC is at its highest peak of concentration within about 3 - 10 minutes of smoking it. Many Chinese medicine practitioners have told me this is their least favorite method due to the amount of heat it puts in the body which is not great for the organs.
Edible / Oil / Topical - This method last the longest in the body, high is the longest and the onset is the slowest. Proceed with caution! Edibles vs Tincture Oils - Oil sublingually (under the tongue) will be a little faster than an edible (especially if already have food in the stomach) with onset time. 10 mins vs 30 mins roughly estimated. The length of time it stays in your system is about the same. Topicals - these are products that go on the skin, like lotions, oils, creams, patches, etc. that usually work best somewhere on the skin that has good veins and large pores, such as the neck, face, feet, hands, buttocks, etc.
Does THC go into the milk?
Tetrahydrocannabinol (THC) is the compound in marijuana. THC is very highly protein bound, to be specific 99.9% protein bound. When taken by mouth, it is very poorly absorbed from the intestinal tract with only 6 - 20% of it being absorbed. Since it is high protein binding, it is unlikely that significant amounts will get into the milk. THC is lipophilic, meaning it likes fat, which includes breast tissue and breastmilk.
How long does it stay in the body?
THC has a long half life, which is the time required for any specified property--the concentration of a substance in the body--to decrease by half. THC can accumulate in our fatty tissues. The longer the half life on a substance, means the longer it takes for the body to eliminate it.
According to Hales Medications and Mothers' Milk, the half life of cannabis is 25 - 27 hours. I speculate that the half life of cannabis when digested vs inhaled may be significantly longer due to the amount of time the "high" lasts and the way it stays in your system and fat stores. Assuming you'd probably need to wait longer to clear the THC from your milk with an edible vs. smoking.
A good rule of thumb is that substance concentration becomes negligible after five half lives. The amounts detected in human milk are very small compared to the adult dose (Hale, 2022; Baker, 2018). The half-life of marijuana is how long it takes for half of the drug to be metabolized and eliminated from the bloodstream and thus your milk since your milk is made from your blood not your fluid intake.
How long should I wait?
The reason you're here...how long should I wait between use and breastfeeding. It peaks around 1 hour in the blood. So it's recommended that you wait at least 4 - 6 hours from the end of consumption to breastfeed a full term healthy well growing baby. To keep up supply during that time, and not skip a feed or pump, you could pump and dump during the 4 hours but you could also use it to make some soap, lotion or butter out of if for yourself with your canna infused breastmilk, what a delicacy!
You may also want to consider having some previously stored milk for the wait and for the rest of day if you are concerned. If you notice a dip in your supply due to smoking, try power pumping to get it back up.
Factors of cannabis half-life
The length of time marijuana remains in your body depends on many different factors, including frequency of use, body mass, metabolism, sex, and hydration levels. Your fluid intake does help your blood which helps your milk. Women often metabolize THC at a slightly slower rate since they tend to have higher levels of body fat than male counterparts.
The effects of marijuana fade quickly, but the drug can be detected in the body for weeks and sometimes longer. The amount of time the active ingredients and breakdown products of weed remain in the system can range from a few hours to 90 days, depending on how often or how much marijuana the person has been using.
For example, according to the UCSD Human Milk Institute, a single dose of weed may be detected in your system for up to 6 days after use, depending on the type of test used. If you rarely smoke weed or only have a few puffs, it will leave your system more quickly than if you use marijuana frequently or heavily.
LactMed (2022) states that the length of time THC can be detected in milk ranges from 6 days to more than 6 weeks. THC may be detected in the body for up to a month after the last use because it is stored in body fat.
Marijuana contains THC and some CBD. THC is secreted into human milk in small quantities, LactMed (2022), or small to moderate amounts. But very little is known about the transfer of cannabidiol (CBD) into human milk. We will dive into that with the next blog!
THC thrives on parts of the body that have a rich blood supply source. Places like the heart, lungs, liver and of course in this case, the chest/breast--which are full of fat and as we know, THC accumulates in our fat tissue and are released or excreted through our feces & urine.
It takes five to six half-lives for a substance to be almost entirely eliminated. This is why you may see general advice that one-time use is probably not detectable after about five to eight days.
Smoking vs. Vaping vs. Edibles
The method of use also impacts the detection time. If marijuana is smoked or vaped, the THC levels in the body will drop faster than if you ingest it. Edibles take longer to break down in the body and leave your system.
What's the effect of each consumption method?
Smoking, there are a few things involved in the process. Cannabis flower, a tool or method for smoking the cannabis (rolling papers, a bong, pipe, etc.), and a lighter. Being mindful of what type of paper is important as some have nicotine which is harmful to milk supply and babies. Non-tobacco organic, hemp, bamboo are safer options for joints.
Most dispensaries have a selection of edibles, including different types of edibles (like cookies, gummies, and chocolate bars), different dosages, and different CBD to THC ratios. Some take the DIY route to whip up cannabis-infused butter or oil, or even cannabis breastmilk butter or cannnabis breastmilk lotion or soap!
But you have to be careful when making edibles at home. While it may seem safer to know what's going in it, it's also harder to control potency and dosing if you do not know what you are doing. With breastfeeding, it's better to be more consistent with dosing to be sure of how much is going in the milk. Professionally manufactured edibles purchased at a reputable dispensary are probably your safer option.
If you choose to smoke cannabis, consider these things:
When you inhale cannabis smoke into your lungs, the active compounds, such as THC, are almost immediately absorbed into the bloodstream, making their way to the brain. Because the time between inhalation and THC reaching the brain is so short, smoking cannabis has a rapid onset. You'll feel the effects of smoking weed almost instantly.
Smoking flower is the lower risk choice over vapes, dabs and blunts.
A clean bong over a pipe adds water vapor so it has less heat, thus less harsh on the body and lungs.
Vapes often have harmful additives and much higher potency. Not advisable.
Some rolling papers may have harmful additives or tobacco, read packaging.
Blunts sometimes have nicotine/tobacco products which is not ideal for milk supply. Tobacco has a different half-life and carcinogens that may cause cancer, reproductive harm and increase risks of SIDS.
Dabs are extremely potent and have a lot of heat with the method used. Too much heat in the body isn't good for our reproductive organs. Not advisable.
When the edible hits...
When you eat an edible, it passes through the digestive tract where it's then absorbed by the stomach. Because an edible has to go through the digestive tract and liver before getting absorbed into the bloodstream, it takes significantly longer for the THC to hit your brain. But once it does, it's stronger and has a longer half-life.
People can over consume more easily with edibles. The process of metabolizing THC can take up to 3 hours. This is why some people may think the edible isn't working, leading them to ingest another edible, increasing their dosage and the intensity and duration of their high. Have a non-consuming friend help keep track of our consumption.
Cannabis & The Law
The FDA has not yet approved medical marijuana for any medical indication, but it is often prescribed for chronic pain, nausea, HIV, multiple sclerosis, glaucoma, and irritable bowel syndrome (IBS).
Although a number of states in the U.S. have active medical marijuana laws and recreational use of marijuana for adults over the age of 21 is legal in 12 states, Washington, DC, the Northern Mariana Islands, and Guam, the federal government continues to classify marijuana as a Schedule I controlled substance.
Recap:
One time or occasional use likely wouldn't be a hinderance to a healthy milk supply, but sustained or prolonged use (daily use over months or years) could possibly.
A high from smoking weed typically lasts 1 - 2 hours whereas an edibles experience can last 4 - 6 hours or more.
THC can be detected in your milk for up to 6 days after use.
THC is lipophilic; it likes fat, meaning breast tissue and breastmilk.
Some THC metabolites have an elimination half-life of 20 hours whereas others are stored in body fat and have an elimination half-life of 6 to 13 days.
The process of metabolizing THC is significantly longer when you ingest an edible, typically anywhere between 45 minutes and 3 hours.
Avoid bed sharing if you smoke; increased risk for SIDS
Avoid if you have a premature or medically fragile baby
Feed baby before using substances; know the wait window; promote attachment even if substance is unsafe.
The choice to use cannabis as a lactating parent depends on many factors. There's no one-size-fits-all approach to consuming cannabis. Choose wisely, make sure you consider all things when decided to use cannabis while breastfeeding. Including age, stage and health condition of your baby.
I highly recommend that families seek professional help and assemble a team of cannabis friendly physicians, pediatricians, lactation consultants, midwives, and other care providers to support them in their choice to use cannabis while lactating.
Now that you understand how both smoking weed and edibles work, you are better informed as to how different consumption methods might work or not work for your breastfeeding relationship. Until next time!
Special Note: This blog series is about breastfeeding not pregnancy. I advise folks to be cautious with marijuana choices prenatally simply because it's harder to determine what is happening to the baby while in utero vs. when a baby is growing out of the womb. This is my personal preference and opinion. However, I do have clients who choose to use cannabis during their pregnancy and I do not shun them for doing so, but I like for people to know there is a difference. Speak with your care provider if you have questions. Nervous, say you heard on TikTok and bring it up causally, asking a hypothetical question rather than for yourself. See how they respond, if they are judgy find someone else. If they are OK, you can safely ask more direct questions.
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