Substance use disorder

Question 1

What is the epidemiology of substance use disorder?

Answer 1

o 33% adults who access drug services are women of reproductive age
o Tobacco > Alcohol > cannabis > other illicit substances
o Polysubstance use is common + psych comorbidities, environmental stressors, limited/disrupted parental care

Question 2

What social problems are associated with substance use disorder?

Answer 2

Housing, crime, children in care/abuse
Co-existent addictions – alcohol or smoking
Malnutrition – iron, vitamin B, C
Risk of viral infections – HIV, Hep B

Question 3

What is associated with alcohol?

Answer 3

more cognitive and behavioural abnormalities:
o Miscarriage, stillbirth, infant mortality, congenital abnormalities, LBW, preterm delivery, SGA
o Foetal alcohol spectrum disorders with later neurodevelopmental abnormalities
o Prenatal drinking associated with long-term effects – cognitive/behavioural change, adverse language outcomes
o Executive functioning defects, psychosocial consequences in adulthood

Question 4

What is associated with smoking?

Answer 4

more distinct outcomes:
Damage to umbilical cord structure			
Miscarriage
Increased risk of ectopic pregnancy			
LBW & preterm birth
Placental abruption				
Increased foetal mortality

Question 5

What is associated with cannabis?

Answer 5

o Preterm labour, LBW, SGA, increased NICU admission
o Prenatal cannabis use linked to:
 Adverse consequences of growth of foetal and adolescent brains
 Reduced attention and executive functioning skills
 Poorer academic achievement
 Behavioural problems

Question 6

What is associated with cocaine?

Answer 6

o PROM
Placental abruption
o Preterm birth
LBW, SGA

o Similar to cocaine, methamphetamine use linked with shorter gestational ages, LBW, foetal loss, developmental and behavioural defects, preeclampsia, gestational HTN, intrauterine foetal death

Question 7

What is associated with opioids?

Answer 7

o	Greater risk of LBW		
Respiratory problems		
3rd trimester bleeding
o	Toxaemia			
Mortality			
Growth deficiency
o	Microcephaly			
Behavioural problems		
SIDS

Question 8

What is neonatal abstinence syndrome?

Answer 8

opiate exposure in utero triggers postnatal withdrawal syndrome
	45-94% of infants exposed to opioids in utero (inc. methadone, buprenorphine) 
	NAS = substantial neonatal morbidity + increased healthcare utilisation
	Presentation:
•	Irritability		
Feeding difficulties		
Tremors
•	Hypertonia		
Emesis				
Loose stools
•	Seizures			
Respiratory distress