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Apsley HB, Brant K, Brothers S, Harrison E, Skogseth E, Schwartz RP, Jones AA. Pregnancy- and parenting-related barriers to receiving medication for opioid use disorder: A multi-paneled qualitative study of women in treatment, women who terminated treatment, and the professionals who serve them. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057231224181. [PMID: 38362719 PMCID: PMC10874161 DOI: 10.1177/17455057231224181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/14/2023] [Accepted: 12/15/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Women face unique barriers when seeking treatment for substance use disorders, often related to pregnancy and parenting. OBJECTIVES This study adds to the extant literature by elucidating the pregnancy- and parenting-related barriers women face when initiating or continuing medication for opioid use disorder, specifically. DESIGN This study is based on qualitative semi-structured interviews. METHODS Three subgroups participated in semi-structured interviews regarding their experiences (N = 42): women with current or past opioid use disorders who have used or were presently using medication for opioid use disorder, professionals working in substance use disorder treatment programs, and criminal justice professionals. RESULTS Three parenting-related subthemes were identified: (1) insufficient access to childcare to navigate appointments and meetings, (2) fear of losing custody of, or access to, one's children, and (3) prioritizing one's children's needs before one's own. Three subthemes were identified with regard to pregnancy as a barrier: (1) hesitancy among physicians to prescribe medication for opioid use disorder for pregnant patients, (2) limited access to resources in rural areas, and (3) difficulty navigating a complex, decentralized health system. CONCLUSION Systemic changes are needed to reduce pregnant and parenting women's barriers to seeking medication for opioid use disorder. These include improved childcare support at both in-patient and outpatient treatment programs, which would assuage women's barriers related to childcare, as well as their fears of losing access to their children if they spend time away from their children for treatment. An additional systemic improvement that may reduce barriers for these women is access to comprehensive, integrated care for their prenatal care, postpartum care, pediatric appointments, and appropriate substance use disorder treatment.
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Affiliation(s)
- Hannah B Apsley
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Kristina Brant
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, University Park, PA, USA
| | - Sarah Brothers
- Department of Sociology and Criminology, The Pennsylvania State University, University Park, PA, USA
| | - Eric Harrison
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Emma Skogseth
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | | | - Abenaa A Jones
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
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Kim SB, White B, Roberts J, Day CA. Substance use among pregnant women in NSW prisons. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 122:104256. [PMID: 37924608 DOI: 10.1016/j.drugpo.2023.104256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION AND AIMS Little is published about pregnant women in custody. Existing data on the prevalence of substance use among incarcerated pregnant women or their needs are scant. This study sought to determine the prevalence and characteristics of women with substance use histories who present to prison pregnant in New South Wales (NSW), Australia. DESIGN AND METHODS A retrospective review of prison medical health records was completed for pregnant women entering New South Wales custodial settings between January 2020 and June 2021. RESULTS We identified 158 prison receptions among 141 pregnant women (median age 28 years [IQR 25-33 years]), 42 % identified as Aboriginal or Torres Strait Islander. Eighty four percent of the women (n = 119) reported recent use of one or more than one substance and 36 % had injected drugs. The most commonly used substances were (meth)amphetamine (60 %), cannabis (40 %) and opioids (28 %). We found discrepancies between drug problems self-reported at reception screening on entry to prison and self-reported drug use collected during the subsequent drug and alcohol specialist assessment while incarcerated. Most (88 %) women described their current pregnancy as unplanned and half (52 %) were unaware they were pregnant before incarceration. CONCLUSIONS These findings highlight the high prevalence of substance use in incarcerated pregnant women and that many women are unaware of their pregnancy prior to incarceration. Findings emphasize the importance of timely and appropriate drug and alcohol assessment and treatment to minimize harm for both the mother and foetus and also underscore the urgent need for enhanced access to contraception for these women.
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Affiliation(s)
- So Bi Kim
- Drug and Alcohol Services, Justice Health Forensic Mental Health Network, Sydney, NSW, Australia; Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia.
| | - Bethany White
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia
| | - Jillian Roberts
- Drug & Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Carolyn A Day
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Edith Collins Centre (Translational Research Centre in Alcohol Drugs and Toxicology), Sydney Local Health District, Camperdown, NSW, Australia
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Harris M, Schiff DM, Saia K, Muftu S, Standish KR, Wachman EM. Academy of Breastfeeding Medicine Clinical Protocol #21: Breastfeeding in the Setting of Substance Use and Substance Use Disorder (Revised 2023). Breastfeed Med 2023; 18:715-733. [PMID: 37856658 PMCID: PMC10775244 DOI: 10.1089/bfm.2023.29256.abm] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Background: The Academy of Breastfeeding Medicine (ABM) revised the 2015 version of the substance use disorder (SUD) clinical protocol to review the evidence and provide updated literature-based recommendations related to breastfeeding in the setting of substance use and SUD treatments. Key Information: Decisions around breastfeeding are an important aspect of care during the peripartum period, and there are specific benefits and risks for substance-exposed mother-infant dyads. Recommendations: This protocol provides breastfeeding recommendations in the setting of nonprescribed opioid, stimulant, sedative-hypnotic, alcohol, nicotine, and cannabis use, and SUD treatments. Additionally, we offer guidance on the utility of toxicology testing in breastfeeding recommendations. Individual programs and institutions should establish consistent breastfeeding approaches that mitigate bias, facilitate consistency, and empower mothers with SUD. For specific breastfeeding recommendations, given the complexity of breastfeeding in mothers with SUD, individualized care plans should be created in partnership with the patient and multidisciplinary team with appropriate clinical support and follow-up. In general, breastfeeding is recommended among mothers who stop nonprescribed substance use by the time of delivery, and they should continue to receive ongoing postpartum care, such as lactation support and SUD treatment. Overall, enhancing breastfeeding education regarding substance use in pregnancy and lactation is essential to allow for patient-centered guidance.
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Affiliation(s)
- Miriam Harris
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
| | - Davida M. Schiff
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Kelley Saia
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Obstetrics and Gynecology, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Serra Muftu
- Divisions of Newborn Medicine and Mass General Hospital for Children, Boston, Massachusetts, USA
- Divisions of General Academic Pediatrics, Mass General Hospital for Children, Boston, Massachusetts, USA
| | - Katherine R. Standish
- Department of Family Medicine, and Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - Elisha M. Wachman
- Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts, USA
- Department of Pediatrics, Chobanian & Avedisian Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
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Doleman G, Geraghty S, DeLeo A. Midwifery student's perceptions of caring for substance-using pregnant women. NURSE EDUCATION TODAY 2019; 76:26-30. [PMID: 30753995 DOI: 10.1016/j.nedt.2019.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 11/20/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
AIM To identify undergraduate and postgraduate student midwives' attitudes towards women using licit and illicit substances during pregnancy. BACKGROUND Literature shows that globally, substance misuse during pregnancy is growing rapidly. Women who use substances during their pregnancy have specific healthcare needs and require midwives to demonstrate positive attitudes to improve appointment compliance and treatment completion. METHODS A cross-sectional quantitative survey design was used. A total of 42 surveys were retained for full data analysis. FINDINGS Of the 42 participants, 22 were undergraduate midwifery students and 20 were postgraduate midwifery students. The results revealed that both undergraduate and postgraduate students had positive attitudes towards women who used substances during pregnancy. Specifically, postgraduate students, with 1-2 years' experience looking after pregnant women, had the most positive attitudes towards substance use in pregnancy. CONCLUSION This study revealed that undergraduate and postgraduate midwifery students have positive attitudes towards women who misuse illicit and licit substances, which is important for providing quality care upon qualification as a registered midwife. It is essential that midwifery students, who will go on to qualify as registered midwives, are non-judgmental and positive to ensure adequate antenatal care and regular antenatal attendance so maternal and fetal wellbeing can be better managed.
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Affiliation(s)
- Gemma Doleman
- Edith Cowan University, Perth, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
| | - Sadie Geraghty
- Edith Cowan University, Perth, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; Charles Darwin University, Australia.
| | - Annemarie DeLeo
- Edith Cowan University, Perth, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.
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Factors influencing recording of drug misuse in primary care: a qualitative study of GPs in England. Br J Gen Pract 2018; 68:e234-e244. [PMID: 29483076 DOI: 10.3399/bjgp18x695309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/20/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Drug misuse is a serious public health problem. Evidence from previous epidemiological studies show that GPs are recording drug misuse in electronic patient records (EPR). However, although the recording trends are similar to national surveys, recording rates are much lower. AIM To explore the factors that influence GPs to record drug misuse in the EPR, and to gain a clearer understanding of the gap between the amount of drug misuse recorded in primary care and that in national surveys and other studies. DESIGN AND SETTING A semi-structured qualitative interview study of GPs working in general practices across England. METHOD Purposive sampling was employed to recruit 12 GPs, both with and without a special interest in drug misuse, from across England. Semi-structured face-to-face interviews were conducted to consider whether and why GPs record drug misuse, which methods GPs use for recording, GPs' actions if a patient asks for the information not to be recorded, and GPs' actions if they think a patient misuses drugs but does not disclose the information. Resulting data were analysed using a combination of inductive and deductive thematic analysis. RESULTS The complexity of asking about drug misuse preceded GPs' decision to record. They described how the context of the general practice protocols, interaction between GP and patient, and the questioning process affected whether, how, and in which circumstances they asked about drug use. This led to GPs making a clinical decision on whether, who, and how to record in the EPR. CONCLUSION When making decisions about whether or not to record drug misuse, GPs face complex choices. Aside from their own views, they reported feelings of pressure from the general practice environment in which they worked and their clinical commissioning group, as well as government policies.
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Metz VE, Brown QL, Martins SS, Palamar JJ. Characteristics of drug use among pregnant women in the United States: Opioid and non-opioid illegal drug use. Drug Alcohol Depend 2018; 183:261-266. [PMID: 29310077 PMCID: PMC5803362 DOI: 10.1016/j.drugalcdep.2017.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/24/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The opioid epidemic in the US is affecting pregnant women and their offspring, with rising numbers of maternal and neonatal treatment episodes. The aim of this study was to characterize pregnant drug users in order to inform intervention strategies based on sociodemographic, mental health, and substance use characteristics. METHODS Data on pregnant women aged 18-44 reporting past-year, nonmedical opioid use or use of non-opioid illegal drugs (other than marijuana) were analyzed from the National Survey on Drug Use and Health (2005-2014). Women (N = 818) were categorized into 3 groups: 1) use of opioids only (n = 281), 2) opioid-polydrug users (n = 241), and 3) other (non-opioid) illegal drug users (n = 296). Characteristics between the 3 groups of women were compared using bivariable analyses. RESULTS Most women were non-Hispanic White (67.6%), had a high school diploma or less education (61.0%), a household income <$20,000/year (72.2%), and health insurance coverage (84.3%). No significant differences between the three groups were found regarding sociodemographic characteristics. Past-30-day marijuana use was less prevalent among opioid-only users (10.9%) compared to opioid-polydrug users (43.6%) and other pregnant illegal drug users (27.6%) (P < 0.001) and past-year drug/alcohol treatment was less prevalent among opioid-only users (6.3%) compared to opioid-polydrug users (20.3%) and other illegal drug users (8.3%) (P = 0.002). Opioid-only users also reported lower prevalence of past-year depression (P < 0.001) and anxiety (P = 0.039). CONCLUSIONS Pregnant drug-using women were often of low socioeconomic status, with mental health and substance use patterns suggesting the need for targeted mental health/substance use screening and interventions before and during pregnancy, particularly for opioid-polydrug users.
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Affiliation(s)
- Verena E. Metz
- Friends Research Institute, Inc., San Francisco, CA, USA,Corresponding author at: Friends Research Institute, 44 Gough Street, Suite 203, San Francisco, CA 94103, USA. (V.E. Metz)
| | - Qiana L. Brown
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA,TrendologyIT Corporation, Baltimore, MD, USA
| | - Silvia S. Martins
- Columbia University, Mailman School of Public Health, Department of Epidemiology, New York, NY, USA
| | - Joseph J. Palamar
- New York University Langone Medical Center, Department of Population Health, New York, NY, USA
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Harris BS, Bishop KC, Kemeny HR, Walker JS, Rhee E, Kuller JA. Risk Factors for Birth Defects. Obstet Gynecol Surv 2017; 72:123-135. [PMID: 28218773 DOI: 10.1097/ogx.0000000000000405] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Major congenital abnormalities, or birth defects, carry significant medical, surgical, cosmetic, or lifestyle consequences. Such abnormalities may be syndromic, involving multiple organ systems, or can be isolated. Overall, 2% to 4% of live births involve congenital abnormalities. Risk factors for birth defects are categorized as modifiable and nonmodifiable. Modifiable risk factors require thorough patient education/counseling. The strongest risk factors, such as age, family history, and a previously affected child, are usually nonmodifiable. Objective This review focuses on risk factors for birth defects including alcohol consumption, illicit drug use, smoking, obesity, pregestational diabetes, maternal phenylketonuria, multiple gestation, advanced maternal age, advanced paternal age, family history/consanguinity, folic acid deficiency, medication exposure, and radiation exposure. Evidence Acquisition Literature review via PubMed. Results There is a strong link between alcohol use, folic acid deficiency, obesity, uncontrolled maternal diabetes mellitus, uncontrolled maternal phenylketonuria, and monozygotic twins and an increased risk of congenital anomalies. Advanced maternal age confers an increased risk of aneuploidy, as well as nonchromosomal abnormalities. Some medications, including angiotensin converting enzyme inhibitors, retinoic acid, folic acid antagonists, and certain anticonvulsants, are associated with various birth defects. However, there are few proven links between illicit drug use, smoking, advanced paternal age, radiation exposure, and statins with specific birth defects. Conclusions and Relevance Birth defects are associated with multiple modifiable and nonmodifiable risk factors. Obstetrics providers should work with patients to minimize their risk of birth defects if modifiable risk factors are present and to appropriately counsel patients when nonmodifiable risk factors are present.
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Affiliation(s)
| | | | - Hanna R Kemeny
- Medical Student, Duke University School of Medicine, Durham
| | - Jennifer S Walker
- Research Librarian, Health Sciences Library, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jeffrey A Kuller
- Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
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Davies H, Gilbert R, Johnson K, Petersen I, Nazareth I, O'Donnell M, Guttmann A, Gonzalez-Izquierdo A. Neonatal drug withdrawal syndrome: cross-country comparison using hospital administrative data in England, the USA, Western Australia and Ontario, Canada. Arch Dis Child Fetal Neonatal Ed 2016; 101:F26-30. [PMID: 26290479 DOI: 10.1136/archdischild-2015-308948] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/24/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We determined trends over time in the prevalence of neonatal drug withdrawal syndrome (NWS) in England compared with that reported in the USA, Western (W) Australia and Ontario, Canada. We also examined variation in prevalence of NWS according to maternal age, birth weight and across the English NHS by hospital trusts. DESIGN AND SETTING Retrospective study using national hospital administrative data (Hospital Episode Statistics) for the NHS in England between 1997 and 2011. NWS was identified using international classification of disease codes in hospital admission records. We searched the research literature and contacted researchers to identify studies reporting trends in the prevalence of NWS. MAIN OUTCOME MEASURES Prevalence of NWS by calendar year per 1000 live births for each country/state. For births in England, prevalence by maternal age group and birth weight group. Prevalence by NHS trust and region at birth, and funnel plot to show outlying English NHS hospital trusts (>3 SD of mean prevalence). MAIN RESULTS Mean prevalence rates of recorded NWS increased in all four countries. Rates stabilised in England and W. Australia from the early 2000s and rose steeply in the USA and Ontario during the late 2000s. The most recent prevalence rates were 2.7/1000 live births in England (2011; 1544 cases); 2.7/1000 in W. Australia (2009); 3.6/1000 in the USA (2009) and 5.1/1000 in Ontario (2011). The highest prevalence in England was among babies born to mothers aged 25-34 years at delivery and among babies born with low birth weight (1500-2500 g). In England in 2011, 8.6% of hospital trusts had a recorded prevalence outside 3 SD of the overall average (7% above, 1% below). The North East region of England had the highest recorded prevalence of NWS. CONCLUSIONS Although recorded NWS is stable in England and W. Australia, rising rates in the USA and Ontario may reflect better recognition and/or increased use of prescribed opiate analgesics and highlight the need for surveillance. The extent to which different prevalence rates by hospital trust reflect variation in occurrence, recognition or recording requires further investigation.
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Affiliation(s)
- Hilary Davies
- Department of Primary Care and Population Health, UCL, London, UK
| | - Ruth Gilbert
- Department of Population, Policy and Practice Programme, UCL Institute of Child Health, London, UK
| | | | - Irene Petersen
- Department of Primary Care and Population Health, UCL, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, UCL, London, UK
| | | | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Trends of people using drugs and opioid substitute treatment recorded in England and wales general practice (1994-2012). PLoS One 2015; 10:e0122626. [PMID: 25923806 PMCID: PMC4414600 DOI: 10.1371/journal.pone.0122626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 02/23/2015] [Indexed: 11/26/2022] Open
Abstract
Background Illicit drug use is a multifaceted public-health problem with potentially serious impacts. The United Kingdom has one of the highest prevalence of illegal drug use in Europe. Reduction of overall illegal drug use in England and Wales has decreased from 11% to 8.2% (2012/13) over the past 10 years. People who use drugs often seek help from their family doctors. Aims To investigate General Practitioners (family doctors) first recording of drug use and opioid substitute treatment in primary care settings. Design A descriptive study design. Males and females (16-64 years old) were extracted from The Health Improvement Network (THIN) database. Setting England and Wales primary care. Method The first recording of drug use and opioid substitution treatment in primary care was estimated for the period (1994-2012). Poisson regressions were conducted to estimate incidence risk ratios (IRR). Results We identified 33,508 first recordings of drug use and 10,869 individuals with prescriptions for opioid substitute treatment. Overall, males (IRR 2.02, 95% CI:1.97–2.07), people in the age-group; 16-24 (IRR 6.7, 95% CI:6.4–6.9) compared to those over 25 years and the most deprived (IRR 4.2, 95% CI:3.9–4.4) were more likely to have a recording of drug use. Males (IRR 1.2 95% CI:1.2–1.3), in the age-group; 25-34 (IRR 1.8 95% CI:1.7–1.9) and the most deprived (IRR 3.9 95% CI:3.6–4.3) were the groups more likely to have a opioid substitute treatment prescription. Conclusion It is evident from this study that there is little recording of drug use and opioid substitute treatment in primary care. Most drug users do not receive treatment in primary care.
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O'Connor A, Lewis L, McLaurin R, Barnett L. Maternal and neonatal outcomes of Hepatitis C positive women attending a midwifery led drug and alcohol service: A West Australian perspective. Midwifery 2015; 31:793-7. [PMID: 25957760 DOI: 10.1016/j.midw.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 04/09/2015] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND the Women and Newborn Drug and Alcohol Service (WANDAS) is a specialist, midwifery-led service providing pregnancy care to women dealing with alcohol and other drug (AOD) use, at the sole tertiary maternity hospital in Western Australia. AIM to assess the antenatal, intrapartum and neonatal outcomes of women with Hepatitis C (HCV) who attended the WANDAS service between 2009 and 2012. DESIGN this retrospective cohort study used data obtained from computerised midwifery records. Univariate comparisons between those who were HCV positive and those who were not, were performed. Multivariable logistic regression was utilised to investigate the simultaneous factors associated with being HCV positive and an opiate user. FINDINGS the incidence of HCV in this cohort was 37% (213 of 570). Compared to those who were HCV negative those who were positive were more likely to: be older (P<0.001); use opioids in pregnancy (P<0.001); be an intravenous drug user (P<0.001); engage in polysubstance use (P<0.001); and receive an induction of labour (P=0.036). There were no intrapartum characteristics found to be significant at a multivariate level associated with being HCV positive and an opiate user, but there were a couple of neonatal complications. These were having a baby admitted to Special Care Nursery (OR 1.95, 95% CI 1.33-2.88, P<0.001) and a baby at increased risk of being diagnosed with neonatal abstinence syndrome (OR 3.40, 95% CI 2.24-5.15, P<0.001). CONCLUSION our findings highlight the complexity of caring for pregnant women who are HCV positive, they also highlight that all pregnant women who are AOD users are an at risk population. IMPLICATIONS FOR PRACTICE these results improve our understanding of the obstetric and midwifery issues associated with caring for pregnant women who are HCV positive and the value of provision of specialist care from a multidisciplinary team, led by a consultant midwife.
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Affiliation(s)
- Angela O'Connor
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia. angela.o'
| | - Lucy Lewis
- School of Nursing and Midwifery, Curtin University, Western Australia, Australia; Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Renate McLaurin
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
| | - Lisa Barnett
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia.
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Casper T, Arbour MW. Identification of the Pregnant Woman Who Is Using Drugs: Implications for Perinatal and Neonatal Care. J Midwifery Womens Health 2013; 58:697-701. [DOI: 10.1111/jmwh.12087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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McLaurin R, Geraghty S. Placenta praevia, placental abruption and amphetamine use in pregnancy: A case study. Women Birth 2013; 26:138-42. [DOI: 10.1016/j.wombi.2012.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 09/25/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE A comprehensive treatment program for schizophrenia needs to include services to women of childbearing age that address contraception, pregnancy, and postpartum issues, as well as safe and effective parenting. To update knowledge in these areas, a summary of the recent qualitative and quantitative literature was undertaken. METHOD The search terms 'sexuality,''contraception,''pregnancy,''postpartum,''custody,' and 'parenting' were entered into PubMed, PsycINFO, and SOCINDEX along with the terms 'schizophrenia' and 'antipsychotic.' Publications in English for all years subsequent to 2000 were retrieved and their reference lists further searched in an attempt to arrive at a distillation of useful clinical recommendations. RESULTS The main recommendations to care providers are as follows: take a sexual history and initiate discussion about intimate relationships and contraception with all women diagnosed with schizophrenia. During pregnancy, adjust antipsychotic dose to clinical status, link the patient with prenatal care services, and help her prepare for childbirth. There are pros and cons to breastfeeding while on medication, and these need thorough discussion. During the postpartum period, mental health home visits should be provided. Parenting support is critical. CONCLUSION The comprehensive treatment of schizophrenia in women means remembering that all women of childbearing age are potential new mothers.
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Affiliation(s)
- M V Seeman
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Lucke JC, Hall WD. Under what conditions is it ethical to offer incentives to encourage drug-using women to use long-acting forms of contraception? Addiction 2012; 107:1036-41. [PMID: 22324856 DOI: 10.1111/j.1360-0443.2011.03699.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
AIMS To stimulate debate by examining ethical issues raised by Project Prevention, a US-based organization that offers $US300 to addicted individuals who agree to either undergo surgical sterilization or use long-acting forms of contraception. METHOD An analysis of key ethical questions raised by Project Prevention. RESULTS The important issues for debate are: (i) what are the reproductive rights of drug-using women; (ii) does a substantial cash incentive undermine the ability of addicted women to make free and informed decisions about long-term contraception; and (iii) how can we best assist addicted women to access good reproductive health care and obtain treatment for their addiction? CONCLUSIONS We need more research on ways in which small non-cash incentives for reversible methods of contraception could be used in a morally acceptable and effective way to promote the sexual, reproductive and general health of addicted women.
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Affiliation(s)
- Jayne C Lucke
- The University of Queensland, UQ Centre for Clinical Research, Herston, QLD, Australia.
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