A review of new psychoactive substances (including synthetic cannabinoids) found that some accumulate in breast milk with potential neonatal toxicity that is largely unrecognized by healthcare providers.
Read this if you are a healthcare provider, or a nursing parent who has used synthetic cannabinoids or other new psychoactive substances.
~1,000 NPSsNumber of new psychoactive substances documented as of 2020, many with unknown neonatal toxicity
What the researchers found
Nearly 1,000 new psychoactive substances have been documented as of 2020. NPS use is associated with higher rates of unplanned pregnancy. Up to 4 in 100 women seeking substance abuse treatment are pregnant or nursing. Animal studies and case reports show that certain NPS exposure during lactation can cause neonatal toxicity including brain damage. Using prediction models, the review identified synthetic cannabinoids and their metabolites as highly accumulative in breast milk. This neonatal toxicity is usually unrecognized by healthcare professionals.
Why it matters
Synthetic cannabinoids are commonly used by young adults, and their accumulation in breast milk poses an underrecognized risk to nursing infants. Healthcare providers need awareness of this emerging issue.
The numbers in context
- ~1,000 NPSs documented as of January 2020
- Up to 4 in 100 women in substance treatment are pregnant/nursing
- Synthetic cannabinoids identified as highly accumulative in breast milk
- Examples: synthetic cannabinoids, cathinones, phenethylamines, piperazines
How the study worked
Review article integrating animal studies, clinical case reports, and computational prediction models to assess neonatal toxicity of NPSs, with emphasis on synthetic cannabinoids and breast milk accumulation.
Who was studied
Neonates potentially exposed to new psychoactive substances through breast milk
What this study cannot tell us
Primarily based on animal data and prediction models. Limited human case report data. Actual breast milk concentrations of most NPSs have not been measured in humans. The rapid emergence of new compounds outpaces safety research.
How to read the evidence
Narrative review integrating animal data, case reports, and prediction models. Raises important concerns but empirical human data is very limited.
When this study was published
Published in 2023. Addresses an emerging and largely unrecognized public health issue.
The bigger picture
As new psychoactive substances proliferate, the gap between their availability and our understanding of their effects on the most vulnerable populations — developing fetuses and nursing infants — grows wider.
Questions still open
- Should lactating women be routinely screened for NPS use?
- How long do synthetic cannabinoids persist in breast milk after last use?
- Do current neonatal toxicology panels detect synthetic cannabinoids?
Read the original research
Potential neonatal toxicity of new psychoactive substances.
Pharmacology & therapeutics, 248, 108468
Citation
Fujiwara, Ryoichi; Journey, Megan; Al-Doori, Fatimah; Bell, Paris; Judge, Brahmjot; Miracle, Kamille; Ito, Kousei; Jones, Sabrina. (2023). Potential neonatal toxicity of new psychoactive substances.. Pharmacology & therapeutics, 248, 108468. https://doi.org/10.1016/j.pharmthera.2023.108468