Around 30 000 pregnant women are estimated to be using opioids in Europe
Every year, some 30 000 pregnant women are estimated to be using opioids in Europe. In an article published in Eurosurveillance, EMCDDA authors explore the public health challenges related to problem drug use and pregnancy in Europe today as well as the intervention strategies likely to alleviate them (1). The article reviews four challenges in particular: treatment of drug dependence; infectious disease transmission; dual diagnosis (co-morbidity of substance use and mental illness); and poor social and personal welfare (e.g. homelessness, intimate partner violence).
For pregnant women using drugs, treatment for drug dependence involves not only a stabilisation in their health and social situation, but also offers an opportunity for contact with standard antenatal and other health care services. Pregnant drug users are at a higher risk than other pregnant women of contracting blood-borne and sexually transmitted infections. While policies vary across countries, standard antenatal care programmes in most European countries today include voluntary screening for infections (e.g. HBV, HCV, HIV, syphilis). Such screening can provide the mother with early diagnosis and appropriate treatment and help reduce the risk of mother-to-child transmission. However, many pregnant drug users still receive suboptimal antenatal care due to poor access to regular services. According to the article, antenatal services geared to the general population need also to cater to the needs of pregnant drug users.
Dual diagnosis is common among drug using populations, with around three-quarters of clients enrolled in drug treatment in Europe reporting a mental health problem. Pregnancy is seen as a unique opportunity to help female drug users enrol in special treatment and support programmes addressing co-morbidity. Finally, the article describes how one in 10 drug users entering treatment in Europe lives in unstable conditions or is homeless. Homeless pregnant drug users are less likely to seek drug treatment than those who are domiciled, and, when in treatment, are less likely to maintain abstinence.
The article proposes that treatment and care for pregnant drug users should offer multidisciplinary interventions encompassing: prevention, screening and treatment of infectious diseases; mental health; personal and social welfare; gynaecological/obstetric care; and drug use. It concludes that risks to mother and child can be reduced via a coordinated and integrated approach involving obstetricians, addiction counsellors, social workers, general practitioners and other health care specialists.
(1) Gyarmathy, V.A., Giraudon, I., Hedrich, D., Montanari, L., Guarita, B., Wiessing, L. (2009), ‘Drug use and pregnancy — challenges for public health’, Eurosurveillance, Volume 14, Issue 9.
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