Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study

Charles S Cornford, Helen J Close, Roz Bray, Deborah Beere, James M Mason, Charles S Cornford, Helen J Close, Roz Bray, Deborah Beere, James M Mason

Abstract

Objective: The contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.

Method: This retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20-61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.

Results: Drug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception.

Conclusions: This is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

References

    1. Hay G, Anderson R, Millar T (2013) National and Regional Estimates of the prevalence of opiate and/or crack cocaine use 20110–11. NHS National Treatment Agency for Substance Misuse. Available: . Accessed 01 July 2014.
    1. Behnke M, Smith VC (2013) Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics. 131(3): e1009–1024. 10.1542/peds.2012-3931
    1. Advisory Council on the Misuse of Drugs (2003) Hidden Harm: Responding to the needs of children of problem drug users Advisory Council on the Misuse of Drugs. London, Home Office.
    1. Cotton-Oldenburg NU, Jordan BK, Martin SL, Kupper L (1999) Women inmates’ risky sex and drug behaviors: are they related? American Journal of Drug and Alcohol Abuse 25(1): 129–149.
    1. Jessup MA, Brindis CD (2005) Issues in reproductive health and empowerment in perinatal women with substance use disorders. Journal of Addictions Nursing 16: 97–105.
    1. Sharpe TT, Velasquez MM (2008) Risk of alcohol-exposed pregnancies among low-income, illicit drug-using women. J Womens Health (Larchmt) 17(8): 1339–1344. 10.1089/jwh.2008.0828
    1. Leppo A (2012) Subutex is safe: perceptions of risk in using illicit drugs during pregnancy. Int J Drug Policy 23(5): 365–373. 10.1016/j.drugpo.2012.01.004
    1. Kearney MH, Murphy S, Rosenbaum M (1994a) Learning by Losing: Sex and Fertility on Crack Cocaine. Qualitative Health Research 4(2): 142–162.
    1. Office for National Statistics (2009) Contraception and Sexual Heath, 2008/09. Available: contra2008–9_tcm77–239214.pdf. Accessed 01 July 2014.
    1. United Nations (2013) Population facts: Trends in contraceptive methods used worldwide. No 2013/9, December 2013. Available: . Accessed 01 July 2014.
    1. Crosby R, Salazar LF, DiClemente RJ, Yarber WL, Caliendo AM, et al. (2004) Health risk factors among detained adolescent females. American Journal of Preventative Medicine 27(5): 401–410.
    1. Armstrong KA, Kenen R, Sarmost L (1991) Barriers to Family Planning Services among Patients in drug treatment programs. Family Planning Perspectives 23(6): 264–271.
    1. Jeal N, Salisbury C (2007) Health needs and service use of parlour-based prostitutes compared with street-based prostitutes: a cross-sectional survey. BJOG 114(7): 875–881.
    1. Banwell C, Bammer G, Main N, Gifford SM, O’Brien M (2003) Disturbingly low levels of contraception among women living with hepatitis C. Australian and New Zealand Journal of Public Health 27(6): 620–626.
    1. Clarke JG, Hebert MR, Rosengard C, Rose JS, DaSilva KM, et al. (2006) Reproductive health care and family planning needs among incarcerated women. Am J Public Health 96(5): 834–839.
    1. Ralph N, Spigner C (1986) Contraceptive practices among female heroin addicts. American Journal of Public Health 76: 1016–1017.
    1. Shannon K, Strathdee SA, Shoveller J, Rusch M, Kerr T, et al. (2009) Structural and environmental barriers to condom use negotiation with clients among female sex workers: implications for HIV-prevention strategies and policy. Am J Public Health 99(4): 659–665. 10.2105/AJPH.2007.129858
    1. May T, Hunter G (2006) Sex work and problem drug use in the UK: the links, problems and possible solutions In: Campbell R, O’Neil M, editors. Sex work now. Cullompton: Willan.
    1. Harding C (2003) Contraceptive practice of women with opiate addiction in a rural centre. Australian Journal of Rural Health 11(1): 2–6.
    1. Kidorf M, Disney ER, King VL, Neufeld K, Beilenson PL, et al. (2004) Prevalence of psychiatric and substance use disorders in opioid abusers in a community syringe programme. Drug and Alcohol Dependence 74: 115–122.
    1. Cornford CS, Mason JM, Inns F (2011) Deep vein thromboses in users of opioid drugs: incidence, prevalence, and risk factors. Br J Gen Pract 61(593): e781–786. 10.3399/bjgp11X613115
    1. Marsden J, Farrell M, Bradbury C, Dale-Perera A, Eastwood B, et al. (2008) Development of the Treatment Outcomes Profile. Addiction 103(9): 1450–1460. 10.1111/j.1360-0443.2008.02284.x
    1. Public Health England (2014) Drugs and Alcohol: National Drug Treatment Monitoring System Available: . Accessed 01 July 2014.
    1. Health and Social Care Information Centre (2012) Cervical Screening Programme—England 2011–2012. Available: - top. Accessed 10 October 2013.
    1. Public Health England (2012) Sexually Transmitted Infections Annual Data. Available: . Accessed 01 August 2013.
    1. Family Planning Association (2007) Contraception: patterns of use. Available: . Accessed 01 August 2013.
    1. Office for National Statistics (2010) Characteristics of Mother 2, England and Wales, 2010. Office for National Statistics. Available: . Accessed 01 August 2013.
    1. Sinha C, Guthrie KA, Lindow SW (2007) A survey of postnatal contraception in opiate-using women. J Fam Plann Reprod Health Care 33(1): 31–34.
    1. Jurkovic D, Wilkinson H (2011) Diagnosis and management of ectopic pregnancy. BMJ 342. doi: 10.1136/bmj.d3397
    1. Plugge E, Fitzpatrick R (2004) Factors affecting cervical screening uptake in prisoners. J Med Screen 11(1):48–9.

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