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NETWORK A national newsletter on substance misuse management in primary care
I S S U E 1 2 S E P T E M B E R 2 0 0 5
Substance misuse in
Dr Mary Hepburn, BSc, MD, MRCGP, FRCOG
Senior Lecturer in Women’s Reproductive Health,
Departments of Obstetrics and Gynaecology / Social Policy and Social Work, University of Glasgow.
Princess Royal Maternity, Alexandra Parade, Glasgow G31 2ER.
Adapted From:
Hepburn, M. Substance Abuse in Pregnancy. Current Obstetrics and Gynaecology (2004) 14, 419-425.
Substance misuse during pregnancy adversely affects outcomes both medically and
socially. Consequently, women with problem drug and/or alcohol use have potentially
high-risk pregnancies. It is important that they are provided with multidisciplinary
care, preferably community based, which addresses all their problems both medical
and social, within a single service. The aim of management is stability rather than
abstinence and objectives should be realistic and achievable.
The huge icrease in drug use that occurred during the 1980’s was disproportionately
large among women of reproductive age so both the numbers of drug using women and
latterly their duration of drug use have increased. While drug use occurs throughout
society the type and pattern of drug use that is associated with medical and social
problems is closely associated with socio-economic deprivation. Deprivation (and
Substance misuse in pregnancy 1
associated lifestyles) and substance misuse both adversely affect the health of
Welcome 2
mother and baby so the effects are cumulative. Consequently women with problem
The Effectiveness Strategy 2 drug and/or alcohol use have potentially high-risk pregnancies.
Substitute prescribing in Primary Care
from a Global Perspective 4 Attendance for antenatal care
Connecting drug users to health 5
Service use is less effective in association with both deprivation and substance
Shared Care Coordination- misuse. Late booking for antenatal care by women with problem drug and/or alcohol
How to make shared care schemes work 6
use is variously attributed either to lack of awareness of pregnancy due to the
National training for GPs, primary care menstrual disturbances and amenorrhoea that are common features of drug use or
staff, shared care workers and other
else simply to lack of motivation. However, it has been found that drug-using women
interested parties to work with people
who use crack cocaine 10
are rarely unaware that they are pregnant. Equally non-attendance is due not to lack
Starting from Scratch – Waltham Forest
of motivation but to difficulty in attending services. Services may be inaccessible
Primary Care Trust (PCT) Shared Care
not only geographically but also administratively. A final barrier to attendance is the
Service 10
perceived attitudes of service providers and women who already feel guilty about
Nurse Prescribing within a Primary Care their behaviour can be reluctant to attend services where they fear they will receive
Setting 12
a hostile and judgmental response. They also want to be cared for by staff who are
What does the new Pharmacy contract
knowledgeable about drug use and its’ problems. Consequently the many effective
mean for patients and GP’s? 13
specialised maternity services for drug using women now established in the UK
Dr Fixit on assessment in primary care 14
share a number of common features: access by any route to care delivered by non-
Dr Fixit on getting out of prison 15 judgmental staff who are knowledgeable about substance misuse and community
Bulletin board 16
based multidisciplinary care that addresses both medical and social problems.
…continued on page 8
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