Drug Services Research Articles

A Hard Pill to Swallow: Privacy Implications of Direct-to-Consumer Prescription Drug Services

A Hard Pill to Swallow: Privacy Implications of Direct-to-Consumer Prescription Drug Services

Barriers and facilitators to the implementation of the Flinders Chronic Condition Management Program in outpatient drug and alcohol settings in Australia.

There has been a growing call for drug and/or alcohol dependence to be managed as a chronic condition. The Flinders Chronic Condition Management Program (Flinders Program) was implemented in a drug and alcohol service in Australia in 2019-2022 to explore the feasibility of chronic condition management in outpatient clinics. Implementation involved: adaptation of the Flinders Program; adaptation of clinical procedures; training clinicians and managers; training Flinders Program Accredited Trainers; and system integration. This study aims to explore barriers and enablers to implementation. A qualitative formative evaluation was undertaken. Data included implementation documents (n = 7), responses to open-ended questions in post-training surveys (n = 27), and focus groups and interviews with implementation staff, clinicians, managers and a trainer (n = 16). Data were analysed using the Consolidated Framework for Implementation Research in a 'coding reliability' approach to thematic analysis. Participants responded positively to the Flinders Program's philosophy, processes, tools and training. However, barriers were identified across three Consolidated Framework for Implementation Research domains: (i) outer setting (client suitability and incompatibility with external policies and incentives); (ii) characteristics of individuals (low self-efficacy); and (iii) inner setting (lack of system and workflow integration). Executive support and systems integration are important for the implementation of the Flinders Program in drug and alcohol services. This needs to be achieved within externally mandated key performance indicators for outpatient services. Further research is needed to fully evaluate the potential of a chronic condition management framework in Australian outpatient drug and alcohol services.

Impact of the COVID-19 pandemic on dispensing medicines in the community pharmacy.

The world has faced an unprecedented challenge since COVID-19 emerged as a pandemic, which has led to quarantine and disruptions in drug services. During the pandemic, drug use habits and availability changed, causing a shift in behaviors and, in turn, medicine misuse. In Iraq, this is a major problem because many medicines can be easily obtained. The study aims to describe the pattern of dispensing medications during the pandemic and to evaluate the biochemical and pathological consequences. The analytical, observational, cross-sectional study was performed via a compiled questionnaire for 400 random pharmacists, and the analysis and interpretation of the biochemical and medical reports. Results revealed that dispensing of medications since the COVID-19 outbreak has increased by 74%, and the demand for medicines seems higher than required in comparison to the periods before the pandemic, while 60% of the dispensed medicines were taken just in case needed. In addition, the availability of medicines decreased by 61%, and the dispensing of common medicines increased due to the belief in their prophylactic action. Several biochemical abnormalities and pathological consequences were recorded due to the irrational use of medicines, and the highest percentage (12%) was seen in hepatic and liver enzymatic dysfunction and 8% for the endocrine and hormonal abnormalities. It can be concluded that most of the dispensed medicines were not used on a therapeutic or scientific basis during the pandemic.

Understanding and learning from rural drug service adaptations to opioid substitution therapy during the COVID-19 pandemic: the What C-OST? study.

In April 2020, in response to government COVID-19 advice, changes were made to the way English drug services operated. Methadone and buprenorphine were typically dispensed in 1- to 2-week supplies, and key working was conducted by phone/online. Previous studies have examined the impact of these changes on people from urban settings. This study adds the experiences and perspectives of people receiving care from drug services in rural areas and makes suggestions for future emergency planning. Telephone semi-structured interviews were conducted with 15 people receiving care in Somerset, Wiltshire, and Suffolk, rural counties in England. Reflexive thematic analysis was used. Three overarching themes were found. "Challenges of rural lockdown" (theme 1) describes how rural community challenges, especially reduced or no rural public transport, were experienced. This hampered some OST collections, with consequential drug use. It also impeded connections to loved ones, worsening isolation. For participants who were struggling pre-pandemic, the intersection between this and their experience of revised drug service operations is embodied in "Amplification of Social Disconnection: Cut off and unheard" (theme 2). They felt a lack of support, particularly from remote provision key working. Participants who had supportive relationships and time in the pandemic occupied in ways they found meaningful, and others who struggled with anxiety or depression, found pandemic changes "Fits better with my life" (theme 3). They experienced more freedom for other things, gained support by other means, such as family, or felt more comfortable with remote engagement. A cross-cutting sub-theme "Understandable Interruptions" showed acceptance of pandemic disruptions. National guidance and organizational policy impacted participants in different ways. Those who had supportive relationships and occupied time were better able to make positive use of newfound freedoms and engage with community-level support. In contrast, those who had less stability, including mental health struggles and social isolation, felt cut off and unheard, particularly from key workers. Reduced rural transport was a significant community-level issue, which impeded OST collection and social support. We suggest emergency response plans be created for individuals taking account of their pre-existing personal situations.

Identifying Potential Improvements In Drug Service Processes At Rs X Semarang Pharmacy Installation: Lean Management Approach

Identifying Potential Improvements In Drug Service Processes At Rs X Semarang Pharmacy Installation: Lean Management Approach

Evaluation of a person-centred, nurse-led model of care delivering hepatitis C testing and treatment in priority settings: a mixed-methods evaluation of the Tasmanian Eliminate Hepatitis C Australia Outreach Project, 2020–2022

IntroductionAustralia has experienced sustained reductions in hepatitis C testing and treatment and may miss its 2030 elimination targets. Addressing gaps in community-based hepatitis C prescribing in priority settings that did not have, or did not prioritise, hepatitis C testing and treatment care pathways is critical.MethodsThe Tasmanian Eliminate Hepatitis C Australia Outreach Project delivered a nurse-led outreach model of care servicing hepatitis C priority populations in the community through the Tasmanian Statewide Sexual Health Service, supported by the Eliminating Hepatitis C Australia partnership. Settings included alcohol and other drug services, needle and syringe programs and mental health services. The project provided clients with clinical care across the hepatitis C cascade of care, including testing, treatment, and post-treatment support and hepatitis C education for staff.ResultsBetween July 2020 and July 2022, a total of 43 sites were visited by one Clinical Nurse Consultant. There was a total of 695 interactions with clients across 219 days of service delivery by the Clinical Nurse Consultant. A total of 383 clients were tested for hepatitis C (antibody, RNA, or both). A total of 75 clients were diagnosed with hepatitis C RNA, of which 95% (71/75) commenced treatment, 83% (62/75) completed treatment and 52% (39/75) received a negative hepatitis C RNA test at least 12 weeks after treatment completion.ConclusionsProviding outreach hepatitis C services in community-based services was effective in engaging people living with and at-risk of hepatitis C, in education, testing, and care. Nurse-led, person-centred care was critical to the success of the project. Our evaluation underscores the importance of employing a partnership approach when delivering hepatitis C models of care in community settings, and incorporating workforce education and capacity-building activities when working with non-specialist healthcare professionals.

Improving substance use disorder care: Service providers' perceptions on barriers to drug use treatment in the Western Province Sri Lanka

The increasing prevalence of drug use as well as a large number of drug users not seeking treatment is a major concern in Sri Lanka. Drug abuse treatment providers are in a unique position to identify barriers that deter drug users from accessing their services. Hence this study aimed to explore the service providers' perceptions of the barriers to drug users accessing treatment services. A qualitative study was conducted with 12 purposely selected service providers from drug treatment centres representing government, non-government, health and non-health sector institutions in the Western Province. In-depth interviews using a semi-structured questionnaire were used as the data collection method. All interviews were conducted by the Principal Investigator and were manually and digitally recorded. Interview data were transcribed and analysed using the inductive thematic analysis method. Five main themes emerged from the data. The main themes were easily identified as being drug user-related factors and service provider-related factors. Poor drug-related health literacy and negative environmental influences were drug user-related factors which service providers perceived as barriers. Service providers perceived that poor provider training, bureaucratic challenges and poor interagency cooperation are barriers within their own programmes that act as barriers for drug users when accessing treatment services. Service providers perceived that drug users who require treatment confront numerous barriers when accessing the help, they need. It is important to address these barriers in order to improve treatment services for this marginalized group.

Level of service satisfaction of health BPJS patients with drug services at pharmacy X Sibolga City

Health-related issues are one of the most pressing needs of society. Indonesia has government-run health insurance that is directly under its control. When patients obtain services that are considered appropriate or above expectations, patient satisfaction is achieved. This research uses a survey research approach and is descriptive. Surveys distributed to respondents were used to collect data. Eighty respondents who met the inclusion requirements were sampled. The data used is primary data, information obtained directly from respondents, with data collection methods such as providing questionnaires, which are filled in by the respondents themselves and sent back to the researcher. The findings of the study, which were based on SPSS patient characteristics analysis, showed that females accounted for the most significant percentage of respondents (43), followed by the 46-55 years age group (32.5%) and housewives (27.5%), (n=26; 32.5%) had the highest hypertension diagnosis on SPSS analysis, while (n=18; 69%) had the highest drug name of amlodipine. The results, according to the Servqual model, showed that the guarantee dimension had the largest average of 98%(Assurance), while the responsiveness dimension had the lowest average of 92% (waiting time).

THE IMPLEMENTATION OF PHARMACEUTICAL SERVICE STANDARDS IN PHARMACIES OF ROKAN HULU DISTRICT

Currently, pharmaceutical services have experienced a lot of development, which initially used to focus on drug management, but have now turned into drug and clinical pharmacy services aimed at raising the standard of living of patients. Pharmaceutical applications are carried out according to pharmaceutical service standards in pharmacies which serve as the basis for providing services. Minister of Health Number. 73 of 2016 is a benchmark that is always guided by pharmaceutical staff in providing services. In this research, qualitative research was chosen which is descriptive quantitative through a cross sectional approach. The sample is determined using the Non-Probability Sampling technique, namely the Total Sampling type where the total population is determined as a sample. Where the number of samples selected amounted to 25 people. Research data must be in-depth, clear, and specific through in-depth interviews and observations. Data analysis was performed on variables through univariate analysis and bivariate analysis using the Chi Square test with a 95% confidence level. Aspects of infrastructure, Management of Pharmaceutical Supplies and Health Supplies, and administration have a significant relationship to pharmaceutical services at pharmacies in Rokan Hulu district with each sequential p-value being 0.002; 0.003; and 0.003. In improving services in accordance with Permenkes Number. 73 of 2016, it requires qualified facilities and infrastructure, good health management and provision, as well as complete administration.

Supporting drug and alcohol service users to cut down or stop smoking: review and evidence.gaps

Abstract Background Globally, drug and alcohol service users are underserved by smoking cessation and tobacco control services despite their high rates of smoking, smoking-related disease and interest in quitting or cutting down. DASHES (drug and alcohol users help to exit smoking) is developing and evaluating a tobacco harm reduction intervention with service users and staff of specialist third sector and NHS services, public health, and policymakers. It combines NHS Scotland behavioural change, pharmacotherapy, NRT delivered as vapes and tailored support. We sought evidence of approaches on which to build and assess our model. Methods Rapid review of smoking cessation interventions for drugs and/or alcohol service users. Papers screened by title and abstract, extracted using Covidence and appraised by 4 researchers using CASP guidance. Included papers were quality reviewed. We used PROGRESS-PLUS to assess consideration of equity. Narrative synthesis explored components of smoking cessation/reduction interventions. Results We quality reviewed 29 eligible studies. Heterogeneity and lack of power precluded meta-analysis and limited estimation of effect sizes. Some interventions fell short of existing, evidence-based practice. Despite funders and authorities requiring commitment to increasing equity and diversity of research participation, few studies monitored or addressed equity of participation, barriers to smoking cessation or provision of trauma-informed care explicitly. Promising interventions included designs and supportive features that mitigate healthcare inequities for other conditions. Conclusions Our review identified promising components for inclusion in DASHES but effective and equitable delivery of smoking cessation/reduction services for people using drug and alcohol services remains understudied. Lack of attention contributes to the ongoing burden of avoidable disease and death associated with tobacco-related harm in this population. Key messages • Smoking-related inequities will continue and drug and alcohol service users remain underserved by smoking cessation/tobacco control services until gaps in the evidence base are addressed. • Action to assure equity in research participation, quality and design of interventions remains limited and must be addressed by policymakers funders, researchers and services.

A qualitative assessment of key considerations for drug checking service implementation

BackgroundWith many drug-related deaths driven by potent synthetic opioids tainting the illicit drug supply, drug checking services are becoming a key harm reduction strategy. Many drug checking technologies are available, ranging from fentanyl test strips to mass spectrometry. This study aimed to identify key considerations when implementing drug checking technologies and services to support harm reduction initiatives.MethodsKey informant interviews were conducted with harm reduction stakeholders throughout Illinois. Participants included members of existing drug checking services and recovery centers. Interviews were recorded, transcribed, and coded by two researchers using the framework method. Findings were contextualized according to micro (client)-, meso (organization)-, and macro (policy)-level themes.ResultsSeven interviews were conducted with ten participants. Fourier transform infrared spectroscopy was consistently identified as a technology of choice given its accuracy, range of substance detection, portability, and usability. Recommendations included the use of confirmatory testing, which can help address the limitations of technologies and provide a mechanism to train technicians. Locations of drug checking services should maximize public health outreach and leverage existing harm reduction agencies and staff with lived experience, who are critical to developing trust and rapport with clients. Criminalization and loss of privacy were major concerns for clients using drug checking services. Additional issues included the need to raise awareness of the legitimacy of services through public support from governing bodies, and funding to ensure the sustainability of drug checking services.ConclusionsThis research facilitated the identification of issues and recommendations from stakeholders around key considerations for the adoption of drug checking technologies, which not only included the cost and technical specifications of instrumentation, but also broader issues such as accessibility, privacy, and well-trained personnel trusted by clients of the service. Successful implementation of drug checking services requires knowledge of local needs and capacity and an in-depth understanding of the target population.

Evaluation of a decentralized investigational drug service pharmacist in a cancer clinical trial infusion unit.

Investigational drug service (IDS) oversees and manages use of investigational products. There is limited data on utility of pharmacy services in clinical trial conduct and outcomes, specifically on the value of a decentralized IDS pharmacist. This is a quasi-experimental study conducted in an oncology clinical trial infusion unit. A retrospective chart review was done to reflect current practice from January through June 2022. A decentralized IDS pharmacist was piloted in December 2022. Data collected included number and types of consults, personnel requesting the consult, and intervention performed. A satisfaction questionnaire was conducted after the pilot program. A total of 16.3% (173 of 1062 patient visits) of pharmacy consults were completed in the centralized IDS pharmacy model, while 44.5% (81 of 182 patient visits) of pharmacy consults were completed during the decentralized IDS pharmacist pilot, p < .001. Decentralized IDS pharmacist completed 77% (62/81) of the consults during the pilot period. Most common types of consults were toxicity management (20%), electronic medical record issues (17%), and tubing and drug administration issues (16%). More than 80% of respondents to the satisfaction questionnaire responded that implementation of a decentralized IDS pharmacist is acceptable, appropriate, and feasible. This pilot study demonstrated that a decentralized IDS pharmacist in an oncology clinical trial infusion unit improved accessibility to an IDS pharmacist, increased pharmacy consults relevant to patient care and optimized centralized pharmacists medication distribution workflow. Further studies are needed to evaluate patient benefits from implementing decentralized IDS pharmacist in direct patient care activities.

Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia

IntroductionTobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol...

A scoping review of Aotearoa New Zealand women's experiences of substance use, alcohol and drug services

INTRODUCTION: The experiences with healthcare services of women who use substances (WWUS)—especially when pregnant or parenting—are largely missing from research in Aotearoa. This scoping review was conducted to inform doctoral research on a new, integrated parenting and substance-use residential-treatment facility in Auckland: Te Whare Taonga. APPROACH: Two objectives of the review were to: 1) collate insights from experiences of women who use substances; and 2) synthesise strengths and weaknesses within current healthcare and alcohol or other drug (AOD) services to understand what works to support WWUS, particularly those who are pregnant or parenting. Peer-reviewed studies, grey literature, and theses published between 1992–2022 exploring the perspectives and views of WWUS and their experiences of substance use, healthcare services, and AOD-treatment providers in Aotearoa New Zealand, were scoped in multiple databases. FINDINGS: The review evidenced a need for gender-specific or gender-sensitive services that are non-stigmatising, accessible to pregnant or parenting women, and culturally appropriate. Holistic care tailored to individual need was considered important. Barriers to treatment included stigma, wait times, negative experiences of healthcare workers, and a lack of appropriate services to meet women’s needs. CONCLUSIONS: There is a lack of AOD services available to WWUS, and, subsequently, research is limited. However, the findings provide an understanding of how healthcare and treatment providers, social workers, whānau (extended family, family group, can include friends with no kinship ties), community, and funders can provide informed and empathetic support to WWUS, including those who are pregnant and parenting.

Challenges in Palliative Care Provision in Ethiopia: An Exploratory Qualitative Study.

The prevalence of chronic illnesses is increasing at an alarming rate in Ethiopia. However, the existing palliative care service is not adequate to address the palliative care need of the patients and their families. This demands the need to explore, among other things, the challenges in palliative care provision. Thus, this article aimed to examine the challenges of palliative care provision in Ethiopia. The study considered Ethiopia as a case and examined the topic using a qualitative exploratory design. The data used in the study were collected through 29 in-depth interviews and 5 focus group discussions with health professionals and other stakeholders and analyzed using thematic analysis technique with ATLAS-ti 7.0 computer software. This study explored patient-related, provider-related, health system-related and partnership-related challenges/gaps in palliative care in Ethiopia. Patient-related factors include, delay in seeking medical care, lack of awareness of disease conditions, discontinuation of treatment due to inability to pay, a lack of follow-up care by considering cancer diagnosis as end of life/death and preferring dying at home. Provider-related challenges include lack of awareness of palliative care, lack of pre-service/in-service training for health professionals, absence of palliative care in the curricula of health programs and scarcity of research information on palliative care in Ethiopia. Health-system challenges include lack of drug, reagent shortage, limited chemotherapy and radiotherapy services, and weak facility-community linkage. Finally, lack of collaborators between governmental and non-governmental organizations was seen as a challenge to the provision of palliative care in Ethiopia. The study revealed that the challenges to palliative care provision in Ethiopia include patient-related factors, provider-related factors, health facility-related factors and partnership-related factors. Therefore, it is vital to take these challenges into account in order to improve the current palliative care service provision in Ethiopia.

Experiences of peer work in drug use service settings: A systematic review of qualitative evidence.

People with lived or living experiences of drug use and services have been increasingly incorporated into nonpeer-led mainstream organizational settings as a unique workforce. Despite the much discussed effectiveness of peer services in achieving measurable outcomes, limited attention has been given to the experiential aspects of peer work from the perspectives of peers, clients, or others involved. This systematic review synthesized qualitative evidence examining the experiences of peer work in nonpeer-led drug use service settings. It focused on the benefits of incorporating peers as a unique workforce, the challenges they face, and the organizational factors that influence their practices. A search of 15 databases identified 3,940 unique citations, 33 of which met inclusion criteria. Thematic analysis was utilized to synthesize their findings. Foregrounding the uniqueness of peers' shared experience, studies have shown that incorporating peers into nonpeer-led settings can provide benefits at the client, organizational, and societal levels while promoting peers' personal and professional growth. The unique shared experience of peers can also present multidimensional challenges, such as triggering, boundary negotiation, and feelings of being trapped by their peer identity. To fully integrate peers into the system, organizations need to work with them to reconstruct organizational mission, culture, and structures in a way that recognizes and genuine commits to peers' unique values. This review highlights the significance of understanding peer uniqueness for organizations to create nourishing conditions for peer services and calls for future research exploring context- and setting-specific peer roles and organizational enablers and barriers.

International harm reduction indicators are still not reached: results from a repeated cross-sectional study on drug paraphernalia distribution in Germany, 2021

BackgroundTo prevent the transmission of blood-borne infections and reach the elimination of viral hepatitis by 2030, the World Health Organization (WHO) has set the goal to distribute 300 sterile needles and syringes each year per person who injects drugs (PWID). We aimed to assess drug paraphernalia distribution in Germany in 2021, including the WHO indicator, and to analyse changes to the distribution measured in 2018.MethodsWe conducted a repeated cross-sectional study of low-threshold drug services in Germany. We assessed type and quantity of distributed drug paraphernalia and the number of supplied PWID in 2021 using an online and paper-based questionnaire. We conducted a descriptive statistical analysis of data from 2021, assessed fulfillment of the WHO indicator and changes in services that participated 2021 and in the previous study 2018.ResultsFive hundred and eighty-nine of 1760 distributed questionnaires were returned in 2021. 204 drug services from 15 out of 16 federal states confirmed drug paraphernalia distribution, covering 20% of Germany’s rural and 51% of urban counties. 108 services had also participated in 2018. The most frequently distributed paraphernalia for injecting drug use in 2021 were syringes (97% of services), needles (96%) and vitamin C (90%). Pre-cut aluminium foil (79% of services) and pipes (28%) for inhaling, and sniff tubes (43%) for nasal use were distributed less frequently. We found a median reduction in distributed syringes by 18% and by 12% for needles compared to 2018. Of 15 states, two reached the 2030 WHO-target for needles and one for syringes.ConclusionsThe current national estimates and changes from 2018 to 2021 for drug paraphernalia distribution seem far from meeting the WHO target. Reasons could include a change in drug consumption behaviour towards less injecting use and more inhaling, and effects of the COVID-19 pandemic (supply difficulties, social distancing, lockdown, reduced opening hours of services). We observed pronounced regional differences in drug paraphernalia distribution. To close existing gaps, Germany should expand its drug paraphernalia distribution programmes and other harm reduction services, such as drug consumption rooms. Further investigation of determinants for adequate distribution is essential to reduce blood-borne infections in this key population.

Providing better access to oral health care for people receiving substance use treatment: A timely discussion.

Substance use disorders are a risk factor for poor oral health which in turn impacts quality of life. Resultant oral problems contribute to chronic illness, premature mortality, social stigma, embarrassment and reduced opportunities for employment and social interaction. Providing dental services to people with substance use disorders is often difficult due to high rates of oral disease, anxiety, behavioural and drug use changes, and lifestyle factors. Previous studies have demonstrated that alcohol and other drug service clients find accessing and navigating oral health services complex and suggest a multidisciplinary care approach to improve outcomes. In this commentary, we describe individual and structural barriers that limit the use of oral health care among people with substance use disorders, alcohol and other drug clinicians' challenges to integrating oral health into their practice and identify key issues for oral health services in delivering care. We draw on our experience to recommend a multidisciplinary approach be used to develop strategies in order to increase access to oral health services at a standard similar to the general population for clients of alcohol and other drug services.

'It's a fragile open door'-enhancing COVID-19 vaccination rates in people receiving treatment for substance use disorder.

People with substance use disorder are at high risk of harms from COVID-19 infection. Vaccine hesitancy is common in this population and compounds pre-existing barriers to accessing health care. A drug and alcohol service in Sydney, Australia introduced strategies to enhance COVID-19 vaccination in people receiving opioid agonist treatment (OAT). We report vaccination outcomes and staff experiences of this. This mixed methods study (i) retrospectively evaluated vaccine uptake in people accessing OAT and (ii) explored perceptions of staff who delivered vaccination interventions through surveys and semi-structured interviews. Of the 984 patients receiving OAT on 9 December 2021, 90.9% had received the first COVID-19 vaccination and 86.7% the second. Australia wide vaccination rates on that date were 93.1% and 88.7% for first and second doses, respectively. Staff commented that having a deep knowledge, understanding and connection with the patient group drove implementation and success of vaccination interventions. This was further supported by staff engagement with the vaccination interventions, and communication and sharing information, both between staff and with patients. High rates of COVID-19 vaccination can be achieved in a vulnerable population. Engaged staff providing information and facilitating access to healthcare underpin this success.

Hidden in plain sight: Using administrative data to conduct a longitudinal cohort study of children exposed to opioids in pregnancy

ObjectivesChildren of women who use substances are difficult to research at a population-level using traditional research methods due to the complexity of their lives. Resultingly, we have little robust evidence on their outcomes. This study developed an administrative data cohort of children exposed to opioids and explored health outcomes.&#x0D; MethodsUsing data from birth records, antenatal records, prescription data, hospital/psychiatric hospital admissions, and drug and alcohol service data, we identified 6,408 children (born 2009-2019) in Scotland who were exposed to opioids through illicit use and/or medication assisted treatment (i.e. methadone/buprenorphine). A control group (n. 19,089) of children not exposed to opioids were matched on age of mother and Scottish Index of Multiple Deprivation. Data were described and linear and logistic regression models were used to examine the relationship between risk factors (such as drug and alcohol use in pregnancy, gestation at booking and at birth), and key early outcomes.&#x0D; ResultsAlthough the majority of women had their substance use recorded in antenatal records, 28.9\% did not, demonstrating the importance of using multiple administrative datasets to form the cohort. Children in the cohort were more likely to experience a range of adverse outcomes including being born early (17\% born prematurely, compared with 6.5\% in control group), having a below normal Apgar score (the scoring system used to assess newborns shortly after birth) (2.9\% in cohort vs. 1.5\% in controls), having significantly lower birthweight, length and head circumference, and more likely to be removed from their mother prior hospital discharge. Differences between the cohorts remained after controlling for other risk factors including alcohol use, and gestation.&#x0D; ConclusionThis feasibility study brought together a cohort of children usually excluded from traditional forms of research. The research demonstrated early differences in outcomes between exposed children and others from similar socio-economic groups. The next stage of this research is exploring health and development outcomes in the preschool period.