At Home Drug Withdrawal

Sobriety Success

The dependence on sobriety is defined as the state of sobriety. When a person is sober, they can live on a daily basis without their thoughts and behaviors being controlled by substance dependence. They do not feel obliged to use it because they manage to live without it. They see and appreciate so much the benefits of living without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. The success product of sobriety is a step-by-step manual for everyone. The product has been said to be beneficial for many people around the world. The reason why the product is gaining so much popularity among individuals. They see and appreciate so much the benefits of life without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. This strategy encourages you to maintain the long-term vision of recovery. Recognize that this is not a one-off thing, something you try for a few weeks to several months, then return to your previous life. You will be in recovery if you decide it's the life you want to live for the rest of your life. As such, there is no immediate timeline to which you must adhere, nor should you strive to achieve goals that you are clearly not ready to face. Continue reading...

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6 Maternal Cocaine

Cocaine is produced from the leaves ofthe coca plant. It may be taken intranasally or by injection, or it can be smoked. Cocaine's half-life is approx 1 h, and the drug's euphoria lasts 20- 30 min (53). Common street names include coke, snow, flake, blow, and crack. Crack refers to a smokeable form of cocaine made by processing cocaine hydrochloride with sodium bicarbonate and water, which is then heated to free the cocaine alkaloid (base) from the salt. This process allows the drug to burn efficiently. Smoking crack provides a rapid onset of effects comparable to intravenous administration. Cocaine is rapidly metabolized by pseudocholinesterases to benzoylecgonine, which is detected in a urine drug-of-abuse screen for cocaine. Cocaine usually makes the user feel euphoric and energetic. The rewarding effects of cocaine are mediated through the dopaminergic system. The adrenergic effects of cocaine are associated with an increase in heart rate and pulse. Common signs of use include...

62 Fetal Effects of Cocaine

It is difficult to isolate the fetal effects of cocaine from other confounding factors associated with pregnant substance use such as malnutrition, poor prenatal care, and multiple substance use. Furthermore, the dose and pattern of administration of cocaine varies among users. Some studies rely on maternal self-reported drug use or urine drug-of-abuse screens. Despite the limitations of these studies of maternal drug use, news media popularized the idea of crack babies born during the cocaine epidemic of the 1980s. These stories suggested that the babies were born addicted and would suffer lifelong problems. Unfortunately, such negative labels affected the way people perceived these infants and thereby shaped their expectations of the children's future. Some of the negative outcomes observed in children of cocaine users resulted from the poor quality of care provided during infancy, rather than from the direct effects of cocaine in utero. Nonetheless, cocaine diffuses across the...

63 Cocaine and Breast Feeding

Women using cocaine should be advised not to breast-feed because of the risk of passive intoxication of the infant, and ideally these infants should be cared for outside of the home until the mother is able to obtain treatment. Seizures can result from infant cocaine intoxication. However, maternal cocaine use is generally not reported, so that cocaine intoxication is usually unsuspected when an infant is brought in for a medical evaluation of a seizure. Another danger is if the mother smokes crack cocaine, neonates and infants in the area are at risk of intoxication because of passive inhalation (59).

7 Maternal Methamphetamine

Methamphetamine is a derivative of amphetamine. It can be ingested, snorted, smoked, or used intravenously. Because its duration of action lasts 6-8 h, users tend to use it once or twice a day (62). Common street names include speed, meth, tweek, chalk, ice, crystal, and glass. Meth-amphetamine is a potent stimulant, and its effects include increased confidence, wakefulness, and physical activity, as well as euphoria and decreased appetite. Other signs of use include pupil dilation, constant talking, tooth grinding, sweating, and irritability. Chronic, long-term use can cause insomnia, increased blood pressure, paranoia, psychosis, aggression, and mood lability. The toxic effects of methamphetamine include seizures, heart attacks, and strokes (63). Health care providers should be aware that methamphetamine-dependent individuals report a high incidence of domestic and interpersonal violence, which may impact the welfare of the mother and the child (64).

71 Epidemiology ofMethamphetamine

The ease with which methamphetamine can be manufactured is a major factor contributing to its increased use across the country. The highest rates of usage occur among men and women between the ages of 18 and 23. According to the 2000 National Household Survey on Drug Abuse, an estimated 8.8 million people (4 ofthe population) have tried methamphetamine at some time in their lives (65). The recent rise in methamphetamine use across the nation has, of course, led to an increase in the number of pregnant women using methamphetamine. Unplanned pregnancy is a significant concern for this population. A study of female methamphetamine users found high levels of sexual risk behavior, including multiple partners, anonymous sex partners, and high rates of unprotected sex (66). Women of childbearing age may be attracted to methamphetamine because of its appetite-suppressing effects.

72 Fetal Effects ofMethamphetamine

There is a paucity of research on the fetal effects ofmaternal methamphetamine use. The available information associates prenatal methamphetamine use with an increased incidence of placental hemorrhages and premature deliveries. Methamphetamine-exposed infants are at greater risk for IUGR (67) and decreased head circumference (68). Similar to cocaine, withdrawal from methamphetamine is not medically dangerous to the mother or the fetus. Nonetheless, nonspecific neonatal withdrawal symptoms requiring pharmacological interventions have been identified in a very small number of neonates (67). Withdrawal symptoms in nonpregnant methamphetamine users include moderate levels of depression, anhedonia, irritability, sleep disturbance, and poor concentration, which resolve quickly for most individuals (69). Unusual behaviors, such as abnormal reflexes and excessive irritability, have been identified in methamphetamine-exposed neonates (68). It is unclear if prenatal methamphetamine exposure is...

4164 Cocaine

Cocaine is found in mothers' milk (Winecker 2001). It is completely orally bioavailable, and appears in the plasma within 15 minutes. The half-life is less than an hour, and total clearance is less than 5 hours. Urine samples, however, can be positive for 7 days or longer because of the slow excretion of the metabolites. The impact on the nursing infant is known only by case reports (Shannon 1989, Chancy 1988, Chasnoff 1987) describing tachycardia, hypertonia, trembling, and excitation. Recommendation. If a mother takes cocaine, she should pump and discard her milk for 24 hours to assure clearance, A mother who is habituated should not breastfeed.

Risk Factors And Aetiology For Pregnancy Failure

Risk factors include advancing maternal age, previous failed pregnancy, smoking, moderate to heavy alcohol use, cocaine, NSAIDs aspirin (by interference with prostaglandins), fever, caffeine (dose related, questionably secondary to cytochrome P450 enzyme activation) and low folate.

Before We Leave The Sixties

Conservative anger toward the 1960s, even if misdirected and often hypocritical, was not entirely unfounded. A third trend was that from the 1950s to the 1970s, crime, violence, drug abuse, violent deaths, divorce, unwed births, venereal disease, and other problems also rose rapidly. One could argue these trends, which have been depicted as occurring only among young people, would have provided grounds for concern about teen pregnancy and childbearing and, especially, younger, darker fatherhood. The problem is that these dissipating trends occurred with equal vigor among older ages a fact never discussed in any account, to my knowledge. For example, drug abuse deaths among teens rose from around 30 in 1955 to nearly 750 by 1970 (a big increase, even if we accept that the 1950s numbers were drastically undercounted). Ignored was the fact that drug deaths among Americans ages 30 to 59 rocketed from 990 in 1955 to 3,250 in 1970.22 Crime rose among all ages, including a leap in serious...

The Institutionalization Of Public Anxiety

Another 1970s development underscoring this point was the advent of government agencies (and their semi-public and private disciples) chartered to address social problems made visible by the revolutions of the 1960s. Sociologists coined the term moral entrepreneurs to characterize bureaucracies such as the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism in tandem with the growing roster of institutions, private programs, and academics deploring teenage drinking, drugs, pregnancy, mental illness, and a host of largely manufactured crises to compete for dwindling 1970s funding.26 The fact that most of the excesses of the 1960s were ebbing on their own in the 1970s, particularly among younger ages, was an inconvenience to politicians' and agencies' campaigns especially since reductions in teen pregnancy and birth rates appeared to have been in response to liberalized opportunities that provided new education pathways for poorer young women...

Specific psychological difficulties in pregnancy

Most people have heard of 'post-natal depression' and are prepared for the weeks after the birth possibly being difficult, but it still remains something of a 'secret' that depression occurs in pregnancy too. As was stated earlier, we enter pregnancy from a particular place in our lives, which might mean struggling to control alcohol or drug problems, or with a tendency to experience panic attacks or anxiety symptoms in certain situations. Pregnancy can re-ignite old difficulties such as problems with body image and fears about controlling your eating. For women who have experienced childhood sexual abuse, pregnancy may trigger or exacerbate

Fetal Risk Summary

Buprenorphine is currently under investigation as an alternative to methadone maintenance treatment of narcotic dependence (1,2 and 3). The drug has also been studied as an alternative to cocaine, but it is apparently not effective for this use (2). Although these trials have not yet included pregnant women, the advantages of buprenorphine over methadone during gestation may include less respiratory depression at high doses, less toxicity from overdose, less severe withdrawal after abrupt discontinuance of the drug, and potentially less abuse liability (1,2). Of inter est, however, abuse of buprenorphine, often concurrently with opiates, has been reported outside of the United States (4,5). One of these latter citations reported frequent abuse of buprenorphine by pregnant women but provided no outcome data (4). As suggested by the relatively low molecular weight of its hydrochloride salt (about 504), buprenorphine crosses the placenta to the fetus. In a 1997 case report, a 24-year-old...

1472 Blue and Black Cohosh

Another more recent report described a normal weight, term infant born to a healthy 20-year-old woman whose obstetrician advised her to drink a tea made from blue cohosh to facilitate labor 136 . At approximately 26 h of age, the newborn infant began to have seizures and was found to have an evolving infarct in the distribution of the left middle cerebral artery. Urine and meconium were positive for the cocaine metabolite benzoylecgonine, and testing of the contents of the blue cohosh ingested by the mother produced similar results. The authors concluded that either benzoylecgonine is a metabolite of both cocaine and blue cohosh, or the blue cohosh itself was contaminated with cocaine. Regardless, use of this herb during pregnancy is contraindicated. Researchers also caution against the use of black cohosh, which is similarly used to induce labor, although clinical evidence of detrimental effects is lacking 137 .

3 Epidemiology Of Substance Abuse And Pregnancy

Treatment programs provide an additional source of epidemiological data. In the 2002 Drug and Alcohol Services Information System report, 4 of the 363,000 women of childbearing age (15-44 yr) who entered treatment were known to be pregnant at the time of admission (9). Compared with their nonpregnant counterparts, pregnant women 15-44 yr of age were more likely to report cocaine crack (22 vs 17 ), amphetamines methamphetamines (21 vs 13 ), and marijuana (17 vs 13 ) as their primary substance of abuse and less likely to report alcohol (18 vs 31 ) (9).

2214 Drugs of abuse in general excluding alcohol

A Opiates, such as heroin, opium, morphine, and codeine m Stimulants, such as cocaine and amphetamines In the case of the hard drugs heroin and cocaine, it must be considered Lhat the effects on the unborn baby's health are frequently intensified due to polytoxicomania, including alcohol and nicotine. Under socially deprived conditions, malnutrition, infections, and trauma may also have an additional developmental toxic effect. For this reason, miscarriages, prematurity, intrauterine growth restriction, and intrauterine death cannot easily be attributed to a single substance. Drugs in the newborn can be detected not only in the urine, but also just as reliably in the meconium, using radioimmuno-logical procedures (Dahlem 1992) and hair samples (Bar-Oz 2003).

51 Epidemiology of Marijuana

Marijuana is the most frequently used illicit drug in the United States. Of the 6.8 million persons who are classified with either dependence or abuse of illicit drugs, 4.2 million are dependent on or abusing marijuana. This represents 1.8 ofthe total population 12 yr or older and 61.4 of all those classified with illicit drug dependence or abuse (8). There is a strong association between the use of licit and illicit drugs among pregnant women. A 1992 survey conducted by the National Institute of Drug Abuse examined licit and illicit drug use in 2613 pregnant women and found that among women who drank alcohol and smoked cigarettes, 20.4 also used marijuana. Conversely, of those women who said they had not used cigarettes or alcohol, only 0.2 smoked marijuana (42).

Foetal persons foetal patients

Include heavy smoking and drinking or drug abuse, and might also include 'lifestyle' choices such as sleeping rough and not eating properly. In the earlier twentieth century, when the dominant model of pregnancy was that of the foetus as successful parasite, such behaviour would not have been thought particularly dangerous. However, as noted in the introduction, recent research has posited a more competitive model of the relation between mother and foetus. In relation to nutrition, for example, it is now known that the foetus cannot take all that it needs from the mother in times of scarcity. If the foetus is receiving an inadequate supply of nutrients or oxygen from the mother, it will have to make choices, diverting to the brain, for example, blood which would normally go to the liver, lungs and kidneys. While this has an immediate survival value, it will compromise future development. In the light of such knowledge, there is increasing pressure on pregnant women to modify their...

83 Methadone Treatment

The Center for Substance Abuse and Treatment TIP 2 guidelines indicate that methadone maintenance provides many advantages for pregnant opioid-dependent women (76). Methadone prevents the onset of opioid withdrawal for 24 h, reduces drug craving, and blocks the euphoric effects when additional opioids are taken. Methadone maintenance therapy also prevents erratic maternal opioid levels and protects the fetus from repeated episodes of withdrawal that may cause signs of fetal distress. Studies of methadone-maintained pregnant women show an improvement in maternal nutrition and neonatal weights. Methadone maintenance decreases the woman's risk ofHIV infection, hepatitis, and sexually transmitted diseases and reduces behaviors often associated with drug-seeking such as prostitution. In combination with psychosocial treatment, it improves the woman's ability to participate in prenatal care, prepare for the birth of the infant, and provide a stable home (6). Methadone is a synthetic opioid...

9 Legal Issues Surrounding Pregnant Substanceabusing Women

The best outcome for a mother with an addictive disorder is to have integrated substance treatment and psychosocial services, for example, when child protective services is involved. The National Center on Substance Abuse and Child Welfare (NCSACW) was formed to implement collaboration among substance abuse, child welfare, and family judicial systems (91). NCSACW recognizes the detrimental effects of criminalizing substance-using women and is providing education, assistance, and resources to destigmatize addiction and implement treatment. The impact of maternal substance use on the foster care system is enormous. Studies by the Child Welfare League of America found that, in most states, child maltreatment and neglect as a result of parental substance abuse was one of the most common reasons for foster care placement (92). Research shows that 80 of children in foster care are at risk for an array of physical and developmental problems because of prenatal exposure to maternal substance...

Explanation Of Condition

Cocaine is a short-acting central nervous system stimulant, with an effect that is said to be intense, immensely pleasurable but relatively brief. Onset of action is within ten minutes, with a half-life of 20 -90 minutes, depending on the route of administration1. Powder cocaine, cocaine hydrochloride (HCl) is extracted from the leaves of the coca plant it is water soluble and usually snorted, sniffed rubbed into gums or injected. 'Freebase' and 'crack' cocaine are colourless and odourless. They are insoluble in water but soluble in alcohol, ether and acetone. Heating converts them into a stable substance which can be inhaled. Freebase is a flammable compound because ether is used in its extraction hence users risk facial and tracheal burns. Crack cocaine is produced by heating cocaine HCl with sodium bicarbonate, making 'rocks' or crystals. These crackle when heated but are a stable mixture without risk of flam-mability. Cocaine may also be injected, combined with heroin, when it is...

Nonpregnancy Treatment And Care

Lifestyle issues need to be explored to help the user understand their drug habit so that changes can be made to reduce or stop cocaine use. A holistic approach to support is needed to address psychological dependency alongside issues of housing needs, debt management, education and skills acquisition as well as exercise, social activities and nutrition. Crack cocaine and cocaine use can affect the user's sexual function, causing impotence in men and amenorrhea and infertility in women.

C Nutritional Risk Factors in Pregnancy that Require Observation

(g) Smoking, drug addiction, and alcoholism. Physiologic problems may have been present. Pregnant patients who indulge in this category may have major physiologic problems. There is the possibility that the patient may not consume sufficient quantities of nutritious foods and, in addition, can cause major problems to the fetus.

Addictive Disorders

Institute for the Study of Drug Dependence 1999 Drug Situation in the UK - Trends and Update. Report to the European Monitoring Centre for Drugs and Drug Addiction www.doh.gov.uk drugs drugreport.pdf 4. Institute for the Study of Drug Dependence 1999 Drug situation in the UK - Trends and Update. Report to the European Monitoring Centre for Drugs and Drug Addiction www. doh.gov.uk drugs drugreport.pdf 7. Standing Conference on Drug Abuse and Local Government Forum 1998 Drug Using Parents Policy Guidelines for Interagency Working. London Local Government 16.3 Cocaine Addiction 4. Harvey JA and Kosofsky BE (Eds) 2000 Cocaine Effects on the Developing Brain. USA Annals of the New York Academy of Sciences 6. Department of Health 2002 Tackling Crack Cocaine - A National Plan. London Department of Health 8. Gillogley KM, Evans AT, Hansen RL, et al. 1990 The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening. American Journal of Obstetrics and...

Pheochromocytoma in pregnancy

Untreated pheochromocytoma is associated with increased fetal and maternal morbidity and mortality. The maternal mortality rate was 48 before 1969 and 26 in the 1970s, and subsequently it fell to 17 87-89 . Since 1990, approximately 85 of cases have been diagnosed antenatally, perhaps because of increased awareness 84 . In one series, antenatal diagnosis reduced the maternal mortality and the fetal loss rate to less than 1 and 15 , respectively 88 . A hypertensive crisis may be precipitated by abdominal palpitation 84 , drugs, including metoclopramide 87 , or labor. Pheochromocytoma should be actively sought for in patients who have affected family members with von Hippel-Lindau or multiple endocrine neoplasia 2 syndromes 90 . The lack of proteinuria in pheochromocytoma may differentiate pheochromocytoma from hypertension associated with preeclamp-sia. Other potential differential diagnoses include anxiety, cocaine use, pulmonary embolism, and alcohol withdrawal 84 .

Vitamin F essential fatty acids

A lack of DHA supplied to the fetus and neonate via the mother can lead to a variety of long-term problems and conditions, such as hyperactivity, dyslexia, depression, alcoholism, drug addiction and schizophrenia. The decline in fish consumption has led to a reduction in the amount of DHA in the maternal diet. (For food sources see Second trimester above.)

43 Substance Abuse

Although a causal relationship between depression and substance abuse has not been clearly elucidated, the connection between depression and substance abuse (especially smoking and alcohol use) is of note. Depression during pregnancy is significantly associated with prenatal substance abuse. Finnish studies have found substance abuse to be co-morbid with depression in 6.4 of women (56). Also, in a recent US study of 186 pregnant women, 8 were found to have both psychiatric illnesses and substance abuse disorders (57). More critically, a study of1014 women of low SES showed depressive symptoms (as per CES-D scores > 16) to be significantly associated with smoking, as well as alcohol and cocaine use (57a). Alcohol consumption, smoking, and street drug use have been clearly associated with neonatal morbidity and mortality when used or consumed in even small to moderate amounts during pregnancy (9).

Forceps Delivery

Congenital Hyperthyroidism

Abrasion of the nose (sheet burns) in an infant with hyperactivity due to drug withdrawal. At the present time hyperactivity is most commonly seen with drug withdrawal, but may occur in infants experiencing pain, congenital hyperthyroidism, etc. The abrasions and erythema generally develop over prominent body parts such as the nose, ears, cheeks, elbows, and knees. Figure 1.45. Sheet burn of the cheeks in a hyperactive infant who was lying in a pool of regurgitated gastric contents. A similar appearance could occur with hyperactivity in an infant with drug withdrawal alone. Figure 1.46. Abrasions of the knees occurring in an infant with drug withdrawal. This type of lesion, which occurs as a result of repeated hip flexion in a hyperactive infant, is very common.

Recreational drugs

If you have been abusing recreational or lifestyle drugs like cocaine, heroine, amphetamine (Ecstasy pill), or marijuana, it is the most appropriate time for you to quit totally once you are pregnant. Continuing to consume these substances is harmful to your developing baby. They are known to cause miscarriage, bleeding in the placenta, stillbirth, low birth-weight baby and even mental retardation of baby. Birth defects associated with maternal cocaine use include abnormalities of the brain, skull, face, eyes, heart, limbs, intestines, genitals and urinary tract.

Wheel Spinning

Eruptions in drug abuse, crime, HIV, and poor infant health among middle-aged populations that were not supposed to have such problems suggests we have not paid enough attention to root causes. A big reason Americans fail to address real issues, in addition to the sacrifices required to do so, is the constant distraction by phony ones. As detailed in Chapter 9, preoccupation with emotional, culture-war crusades has drowned out serious, scientific analysis. For example, consider the increasingly virulent claim that modern black youth are not victims of poverty and discrimination so much as the corrupting music, dress, and lifestyles they supposedly favor.

Fetal development

The sections that follow will focus on the most relevant sources of potential fetal compromise and include smoking, alcohol, drug abuse, infection and environmental hazards. Information relating to fetal exposure to these influences is collected during the first consultation between the woman and her midwife or doctor, the 'booking history', and recorded in her notes (see Table 5.1). Such data may then be updated throughout the antenatal period.

2215 Opiates

In contrast to alcohol and cocaine, heroin and other opiates do not appear to have any teratogenic potential. In contrast to those children who are damaged by alcohol, problems with neurological development (including cognitive abilities) in the children whose mothers who have abused drugs seems to be more a consequence of the deprived social environment in the first years of life. In such instances, intact family relationships as a result of prompt adoption after birth appear to permit broadly normal development (Ornoy 2001, Coles 1993). Only attention deficits and hyperactivity (ADHD) were noted more often in adopted children than in the unexposed control group. However, there were significant differences between adopted children (37 ) and those children who remained in a drug-taking environment (67 ). This was the result of a follow-up study of 6- to 11-year-old children exposed prenatally (Ornoy 2001). Severe withdrawal symptoms beginning, for the most part, within 24-72 hours...

2216 Stimulants

Cocaine Cocaine (coke, snow) is an alkaloid (benzoecgonine methyl ester) of the coca bush (Erythroxylon coca), which grows primarily in the Andes. The leaves contain about 1 cocaine. Cocaine was first used as an anesthetic in 1884. It is chemically related to local anesthetics, but has only been proven to be of value for external use in treating eyes, ears, nose, and throat conditions. Crack is the free base of cocaine Lhis is smoked. Cocaine blocks the reuptake of noradrenaline and dopamine at the synapse, and in this way increases the catecholamine concentration. This leads to a sympathicomimetic and central stimulating effect. When cocaine is taken orally, it is absorbed very slowly because of its vasoconstrictive action and the hydrolytic breakdown in the stomach. It is metabolized in the liver within 2 hours to the ineffective primary metabolite, benzoecgonine. About 20 is excreted unchanged via the kidneys. Intranasal absorption occurs within 20 minutes (there is a delay as a...

Alcohol

Drug abuse Cocaine Use of this central nervous system stimulant in pregnancy is linked with, shorter body length, reduced head circumference and intrauterine growth retardation associated with placental and uterine vasoconstriction (Polin and Fox 1998). Such effects may be confounded by the fact that cocaine is an appetite suppressant hence its users are often of a poor nutritional status (McNamara 1995). The neonate, although not displaying consistent withdrawal patterns, is likely to be irritable and should therefore be nursed in a calm environment (Nora 1990). In a meta-analysis of over 32,000 women, English et al. (1997) concluded that in the amounts typically consumed by pregnant women cannabis does not cause low birth weight. Unlike many other forms of drug abuse, it has not been linked with an increased risk of perinatal mortality (Zuckerman et al. 1989). It has been suggested, however, that when cannabis is used with other substances, such as alcohol and tobacco in pregnancy,...

Summary

When there is evidence or even the suspicion that the mother has a history of alcohol or drug abuse, the practitioner examining the baby must ensure that the relevant support agencies are involved in the care and long-term support of this vulnerable family unit. Children growing up within this environment are more likely to suffer from physical and emotional neglect, the aetiology of which is complex and beyond the scope of this text. The mother's addiction may be a symptom of abuse that she herself is being or has been subject to and should not therefore be considered in isolation (McFarlane et al. 1996).

4167 Other drugs

Wadlington WB, Cocaine convulsions in a breastfed baby. I Pediatr 1988 112 134-5. Chasnoff IJ. Lewis DE, Squires L. Cocaine intoxication in a breast-fed infant. Pediatrics 1987 80 836-8. Shannon M, Lacouture l'G, Roa et al. Cocaine exposure among children seen at a pediatric hospital. Pediatrics 1989 83 337-42. Winecker RE, Goldberger BA, Tebbett (R et al. Detection of cocaine and its metabolites in breast milk. J Forensic Sei 2001 46 1221-3.

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