Abstract
ObjectiveThe 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.MethodThis 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.ResultsDrug-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.ConclusionsThis 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.
Highlights
In England, women addicted to heroin or crack cocaine account for 4.05/1000 of the population [1]
Little is known about the choices drug-using women make about their contraception, or about subsequent pregnancy outcomes
Data were available for 374 female patients who were receiving treatment for illicit opioid addiction; the mean age was 33 years and 353 (94%) were recorded as white British
Summary
In England, women addicted to heroin or crack cocaine account for 4.05/1000 of the population (aged 15–64) [1]. Heroin use has devastating effects for both men and women, but women are subject to a whole range of additional challenges relating to sexual relations with men, contraception, pregnancy and child bearing [2,3,4,5,6,7,8]. Preconception and prenatal drug and alcohol use may directly cause poor maternal outcomes as well as adverse effects on the developing foetus, with life-long consequences [2]. Little is known about the choices drug-using women make about their contraception, or about subsequent pregnancy outcomes. Much evidence is drawn from undifferentiated populations in which drug use is commonplace
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