FC03-05 - An evaluation of service provision by community drug treatment services for opioid dependent pregnant drug users in England and Wales

Abstract

IntroductionOver the last decade a series of guidelines and recommendations have been published in the UK by the Department of Health, the Home Office, Professional and Non-Professional bodies. However, an optimal strategy and consensus in the management and care of opioid dependent pregnant users has yet to be established.ObjectivesDetermination of existing methods for identifying and managing pregnancy in opioid users prescribed methadone by NHS Treatment Services and regional differences.AimTo survey the management, treatment and follow-up of pregnant opioid users prescribed methadone by Drug Treatment Services in England and Wales.MethodsIn 2006 a POSTAL survey was conducted among 223 Community Drug Treatment Services (CDTS).ResultsSixty-six percent of CDTS responded to the survey (n = 154/233). A Chi-square, Mann_Whitney U Test and/or Kruskal-Wallis analysis revealed significant differences in the composition of CDTS and service provision across regions. Half of CDTS (55.3%) provided a methadone dosage regime lower than that recommended for non-pregnant drug users. There were also significant variations on how professionals approached the management of pregnant opioid users. CDTS with an addiction specialist were significantly more likely (p < .01) to advocate high doses of methadone whereas those with a midwife, obstetrician or social worker involved were more likely (p < .05) to suggest low dose methadone and/or detoxification.ConclusionsService provision for pregnant opioid users is comprehensive but there is still variability in some aspects of the treatment received. The way in which methadone is prescribed is not always optimal. Further work is required in this area.

HIV, HCV, and Health-Related Harms Among Women Who Inject Drugs

“…OST services that are designed specifically for pregnant women are an example of an evidence-based gender-sensitive harm reduction intervention. However, even in countries with well-developed and comprehensive service provision, considerable variability and sub-optimal prescribing has been identified 68,69 .…”

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…A recent survey reports that service provision for opioid dependent pregnant women in England and Wales is generally high, but that variations in practice are evident, particularly in approaches to methadone prescribing (Perez-Montejano, Finch, & Wolff, 2011). This was evident within our sample, with eight participants prescribed OST by their general practitioner at the time of their first interview, and the other eleven prescribed by specialist drug treatment services run by the NHS.…”

Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods

“…Although there are UK clinical guidelines on the use of OST (Department of Health, 2007), practice and policy varies geographically within the UK, and this is the case with OST during pregnancy also. A recent survey reports that service provision for opioid dependent pregnant women in England and Wales is generally high, but that variations in practice are evident, particularly in approaches to methadone prescribing (Perez-Montejano et al, 2011). This was evident within our sample, with eight participants prescribed OST by their general practitioner at the time of their first interview, and the other eleven prescribed by specialist drug treatment services run by the NHS.…”