DOCSLIB.ORG

Licit and Illicit Drug Use During Pregnancy: Maternal, Neonatal and Early Childhood Consequences

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Licit and Illicit Drug Use During Pregnancy: Maternal, Neonatal and Early Childhood Consequences SUBSTANCE ABUSE IN CANADA 2013 Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences By Loretta Finnegan With A Call to Action by Franco Vaccarino and Colleen Dell This document was published by the Canadian Centre on Substance Abuse (CCSA). CCSA activities and products are made possible through a financial contribution from Health Canada. The views of CCSA do not necessarily represent the views of the Government of Canada. The subjects in the photographs used throughout this publication are models who have no relation to the content. The vignettes are fictional and do not depict any actual person. Suggested citation: Finnegan, L. (2013). Substance abuse in Canada: Licit and illicit drug use during pregnancy: Maternal, neonatal and early childhood consequences. Ottawa, ON: Canadian Centre on Substance Abuse. © Canadian Centre on Substance Abuse 2013. CCSA, 75 Albert St., Suite 500 Ottawa, ON K1P 5E7 Tel.: 613-235-4048 Email: [email protected] This document can also be downloaded as a PDF at www.ccsa.ca. Ce document est également disponible en français sous le titre : Toxicomanie au Canada 2013 : Consommation de drogues licites et illicites pendant la grossesse : Répercussions sur la santé maternelle, néonatale et infantile ISBN 978-1-77178-041-4 Licit and Illicit Drug Use during Pregnancy: Maternal, Neonatal and Early Childhood Consequences Prepared for the Canadian Centre on Substance Abuse Loretta P. Finnegan, M.D., LLD, (Hon.), ScD (Hon.); President, Finnegan Consulting, LLC; Professor of Pediatrics, Psychiatry and Human Behavior, Thomas Jefferson University (Retired); Founder and Former Director of Family Center, Comprehensive Services for Pregnant Drug Dependent Women, Philadelphia, PA; Former Medical Advisor to the Director, Office of Research on Women’s Health, National Institutes of Health, U.S. Department of Health and Human Services (Retired) Table of Contents Foreword by Rita Notarandrea 2 Acknowledgements 3 Foreword by Anthony G. Phillips and Dan Goldowitz 4 Introduction 5 1.0 Epidemiology of Maternal Drug Use 8 2.0 Medical and Obstetrical Consequences of Drug Use in Women 14 3.0 Psychosocial Issues and Victimization in Pregnant Women Using Drugs 26 4.0 Outcomes of Newborns of Pregnant Women Using Drugs 34 5.0 Comprehensive Treatment Approaches for Pregnant Women Using Drugs 62 6.0 Early Childhood Outcomes 90 7.0 A Call to Action by Franco Vaccarino and Colleen Dell 106 Appendices 112 SUBSTANCE ABUSE IN CANADA - Licit and Illicit Drug Use during Pregnancy Foreword Every two years, the Canadian Centre on Substance Abuse was to ensure an up-to-date understanding of this area, as it (CCSA) produces a new report in the Substance Abuse in is vital that professionals providing health care and support to Canada series, with each edition shedding much-needed pregnant women are well-informed about the latest evidence. light on an important drug- and alcohol-related issue. The This perspective is considered as part of the educational, current report is devoted to drug use during pregnancy— motivational and tailored tool kit that treatment providers can more specifically, the maternal, neonatal and early childhood employ to connect with women during their pregnancy — a consequences of using substances ranging from tobacco period when women are more likely to seek care and support and alcohol, to marijuana, cocaine and heroin. Through this from the health community. installment, we hope to bring the challenges faced by pregnant women “out of the shadows” so we can better meet their needs Pregnancy is also a period when women might be more and those of their children. motivated to address the potential harms associated with their drug use. Because of this potential, it was considered important While this latest report covers a variety of topics, an important that the report inform and educate treatment providers about aim for CCSA was to ensure that it summarizes the latest what is happening biologically to the fetus. We also took care knowledge in the biomedical literature pertaining to drug use to provide information about the measures that can be taken on and abuse during pregnancy. Through the work of CCSA’s the part of a pregnant woman and her community to reduce the Scientific Advisory Council (SAC) and the leadership of harms to both the mother and her fetus. Dr. Franco Vaccarino, Professor of Psychiatry and Psychology at the University of Toronto, CCSA had the good fortune to A further catalyst for the approach taken in the present report connect with Dr. Loretta Finnegan, a world-renowned expert derives from learnings in the mental health field. The treatment in the fields of women’s health, pediatrics and perinatal provider can relay information to the mother on the biological addiction. Dr. Finnegan authored the report and took the lead context of substance use in pregnancy. This information in researching it. We are deeply grateful for her contributions can help prevent the mother feeling any sense of blame and and fortunate to have been able to draw on her decades of judgment, which feeling could lead to her inaction. experience on this complex issue. The biomedical focus of the report did not permit a Women who use drugs, alcohol and tobacco already face comprehensive, in-depth analysis of the many complex many health and social challenges. These challenges are psychosocial factors associated with drug use during further compounded during pregnancy, when substance use pregnancy. The report does, however, include an important can profoundly affect the earliest stages of human development chapter relating to psychosocial issues, as well as a section and have adverse outcomes that carry into early childhood and highlighting the value of a setting that provides a more holistic beyond. Clearly, we know that drug use has impacts on many and comprehensive approach to care. This information on the lives. During pregnancy it affects the lives of the mother and setting for care underscores the importance of psychosocial child. Drug use also affects — and is affected by — their family, themes such as those related to victimization that were included the larger community in which they live and even society as in the report. It also stresses the central role played by the family a whole through interactions with our healthcare and social and community in any treatment response or prevention effort. systems. This report explores the full spectrum of impacts. The Call to Action found at the end of the report encourages ongoing efforts to integrate biomedical and psychosocial One of the important — but arguably less broadly recognized — approaches to care for women’s drug use, particularly during impacts pertains to the biomedical consequences of drug use pregnancy. and abuse during pregnancy. An important driver for this report 21 Canadian Centre on Substance Abuse SUBSTANCE ABUSE IN CANADA - Licit and Illicit Drug Use during Pregnancy Acknowledgements To meet our goals of producing a report with a broad-based Beyond the invaluable work performed by Dr. Finnegan and international perspective, the report was not designed to Dr. Vaccarino, an initiative of this scope would not be possible be country-specific or to focus only on the state of affairs in without the contributions of many knowledgeable researchers Canada, although it does highlight some Canadian data. For and clinical experts. I would like to take this opportunity to this reason, Dr. Finnegan, the report’s author, was a strong thank the members of CCSA’s SAC for their review of this fit in her capacity as a world expert and she has provided a report and their contributions to it; as well as Dr. Colleen Anne comprehensive, globally relevant report on the impacts of drug Dell, Research Chair in Substance Abuse at the University use during pregnancy on the fetus and on the infant. of Saskatchewan, who co-authored the recommendations outlined in the Call to Action chapter together with Dr. Vaccarino. There are a number of actions we need to take to address the I must also acknowledge the external reviewers who helped challenges. This report is an important reminder of the need finalize the report, including Dr. Peter Selby, Clinical Director of to continue to build our knowledge base as it pertains to the the Addictions Program at the Centre for Addiction and Mental Canadian context. Some of this work will involve closing gaps Health, and Dr. Gideon Koren, Director of the Motherisk Program in the knowledge pertaining to Canada-specific issues and at Toronto’s Hospital for Sick Children. Finally, it goes without some of it will involve adapting the knowledge derived from the saying that CCSA is indebted to Dr. Amy Porath-Waller, Senior international context to a Canadian context. But by concentrating Research and Policy Analyst, for her exceptional leadership and our efforts on the areas identified in the Call to Action — among management of this report together with Dr. Vaccarino, from them, ensuring clinicians and their clients have access to the inception to completion, and to everyone involved in the design latest evidence and adopting a more holistic and multidisciplinary and production of this report. approach to treatment and prevention — we will be able to bring real change to frontline practices and to community responses, Their contributions were invaluable. and we will help countless lives in the process. Rita Notarandrea Deputy Chief Executive Officer Canadian Centre on Substance Abuse Canadian Centre on Substance Abuse 13 SUBSTANCE ABUSE IN CANADA - Licit and Illicit Drug Use during Pregnancy Foreword Non-medical abuse of drugs can occur at any stage of life. Clearly, simple approaches to this most complex form of human When such exposure occurs during pregnancy and in the post- disorder are destined to failure. natal phase, it raises understandable concern about the impact on the health of the mother and child, as well as possible long- The Canadian Institutes of Health Research and NeuroDevNet, term consequences for brain development in the new infant.
Load more

Recommended publications
  • Methadone Maintenance Program: Clinical Practice Guideline
    College of Physicians and Surgeons of Britsh Columbia Methadone Maintenance Program: Clinical Practce Guideline February 2014 Revised July 2014 | Updated September 2015 Methadone Maintenance Program: Clinical Practice Guideline CONTENTS Preface .................................................................................................... 1 Introduction ............................................................................................ 2 1. The History of Methadone .................................................................................................................. 2 2. Authorization to Prescribe Methadone .............................................................................................. 2 2.1 Full Authorization ...................................................................................................................... 3 2.2 Temporary Authorization .......................................................................................................... 4 2.3 Hospitalist Authorization ........................................................................................................... 4 3. Pharmacology of Methadone ............................................................................................................. 4 3.1 Absorption ................................................................................................................................. 5 3.2 Duration of Action/Metabolism ...............................................................................................
    [Show full text]
  • TREATED with CRUELTY: ABUSES in the NAME of DRUG REHABILITATION Remedies
    TREATED WITH CRUELTY ABUSES IN THE NAME OF DRUG REHABILITATION Copyright © 2011 by the Open Society Foundations All rights reserved, including the right to reproduce this book or portions thereof in any form. For more information, contact: International Harm Reduction Development Program Open Society Foundations www.soros.org/harm-reduction Telephone: 1 212 548 0600 Fax: 1 212 548 4617 Email: [email protected] Cover photo: A heroin user stands in the doorway at the Los Tesoros Escondidos Drug Rehabilita- tion Center in Tijuana, Mexico. Addiction treatment facilities can be brutal and deadly places in Mexico, where better, evidence-based alternatives are rarely available or affordable. (Sandy Huf- faker/ Getty Images) Editing by Roxanne Saucier, Daniel Wolfe, Kathleen Kingsbury, and Paul Silva Design and Layout by: Andiron Studio Open Society Public Health Program The Open Society Public Health Program aims to build societies committed to inclusion, human rights, and justice, in which health-related laws, policies, and practices reflect these values and are based on evidence. The program works to advance the health and human rights of marginalized people by building the capacity of civil society leaders and organiza- tions, and by advocating for greater accountability and transparency in health policy and practice. International Harm Reduction Development Program The International Harm Reduction Development Program (IHRD), part of the Open Society Public Health Program, works to advance the health and human rights of people who use drugs. Through grantmaking, capacity building, and advocacy, IHRD works to reduce HIV, fatal overdose and other drug-related harms; to decrease abuse by police and in places of detention; and to improve the quality of health services.
    [Show full text]
  • Symphysio Fundal Height (SFH) Measurement As a Predictor of Birth Weight
    Faridpur Med. Coll. J. 2012;7(2):54-58 � Original Article Symphysio Fundal Height (SFH) Measurement as a Predictor of Birth Weight Z Parvin1, S Shafiuddin2, MA Uddin3, F Begum4 Abstract : Fetal weight is a very important factor to make a decision about labor and delivery. Assuming that in large fetuses, dystocia and other complications like cerebral edema, neurological damage, hypoxia and asphyxia may result during or after the delivery. On the other hand, one of the causes of high perinatal mortality in our country is high rate of low birth weight. Rural people may not have access to ultrasonography which is one of the methods to predict birth weight. For these people alternative easy method is necessary. So we can assess fetal birth weight by measuring symphysio-fundal height. Total 100 consecutive pregnant women of gestational age more than 32 weeks admitted for delivery in the Obstetric and Gynaecology department of Faridpur General Hospital were the subject of this study. After selection of cases, a thorough clinical history was taken and elaborate physical examination was done. Common criteria for collection of data were followed in every case. The fetal weight estimated by Johnson's formula was recorded in the predesigned data sheet and then was compared with birth weight following delivery of the fetus. Collected data were compiled and relevant statistical calculations were done using computer based software. Statistical tests (Correlation) were done between actual birth weight (taken as dependant variable) and fetal weight (found by Johnson's Formula), symphysio fundal height (SFH), pre-delivery weight and height of the patients (taken as independent variables) and the tests revealed that actual birth weight was significantly correlated with fetal weight (found by Johnson's Formula), SFH, pre-delivery weight and height of the patients.
    [Show full text]
  • Magnetic Resonance Imaging
    Published online: 2021-07-30 OBS/GYNEC Magnetic resonance imaging ‑ A troubleshooter in obstetric emergencies: A pictorial review Rohini Gupta, Sunil Kumar Bajaj, Nishith Kumar, Ranjan Chandra, Ritu Nair Misra, Amita Malik, Brij Bhushan Thukral Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India Correspondence: Dr. Rohini Gupta, Department of Radiodiagnosis, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi ‑ 110 029, India. E‑mail: [email protected] Abstract The application of magnetic resonance imaging (MRI) in pregnancy faced initial skepticism of physicians because of fetal safety concerns. The perceived fetal risk has been found to be unwarranted and of late, the modality has attained acceptability. Its role in diagnosing fetal anomalies is well recognized and following its safety certification in pregnancy, it is finding increasing utilization during pregnancy and puerperium. However, the use of MRI in maternal emergency obstetric conditions is relatively limited as it is still evolving. In early gestation, ectopic implantation is one of the major life‑threatening conditions that are frequently encountered. Although ultrasound (USG) is the accepted mainstay modality, the diagnostic predicament persists in many cases. MRI has a role where USG is indeterminate, particularly in the extratubal ectopic pregnancy. Later in gestation, MRI can be a useful adjunct in placental disorders like previa, abruption, and adhesion. It is a good problem‑solving tool in adnexal masses such as ovarian torsion and degenerated fibroid, which have a higher incidence during pregnancy. Catastrophic conditions like uterine rupture can also be preoperatively and timely diagnosed. MRI has a definite role to play in postpartum and post‑abortion life‑threatening conditions, e.g., retained products of conception, and gestational trophoblastic disease, especially when USG is inconclusive or inadequate.
    [Show full text]
  • International Standards for Symphysis-Fundal Height Based on BMJ: First Published As 10.1136/Bmj.I5662 on 7 November 2016
    RESEARCH OPEN ACCESS International standards for symphysis-fundal height based on BMJ: first published as 10.1136/bmj.i5662 on 7 November 2016. Downloaded from serial measurements from the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project: prospective cohort study in eight countries Aris T Papageorghiou,1 Eric O Ohuma,1,2 Michael G Gravett,3,4 Jane Hirst,1 Mariangela F da Silveira,5,6 Ann Lambert,1 Maria Carvalho,7 Yasmin A Jaffer,8 Douglas G Altman,2 Julia A Noble,9 Enrico Bertino,10 Manorama Purwar,11 Ruyan Pang,12 Leila Cheikh Ismail,1 Cesar Victora,6 Zulfiqar A Bhutta,13 Stephen H Kennedy,1 José Villar,1 On behalf of the International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) For numbered affiliations see ABSTRACT visible during examination. The best fitting curve was end of article. OBJECTIVE selected using second degree fractional polynomials Correspondence to: To create international symphysis-fundal height and further modelled in a multilevel framework to A Papageorghiou, Nuffield standards derived from pregnancies of healthy women account for the longitudinal design of the study. Department of Obstetrics & Gynaecology, University of with good maternal and perinatal outcomes. RESULTS Oxford, John Radcliffe Hospital, DESIGN Of 13 108 women screened in the first trimester, 4607 Headington, Oxford OX3 9DU, UK aris.papageorghiou@obs-gyn. Prospective longitudinal observational study. (35.1%) met the study entry criteria. Of the eligible ox.ac.uk SETTING women, 4321 (93.8%) had pregnancies without major Additional material is published Eight geographically diverse urban regions in Brazil, complications and delivered live singletons without online only.
    [Show full text]
  • Impact of Recreational and Medical Marijuana Use During Pregnancy and Lactation on the Newborn
    If it’s Legal it Can’t be all Bad… can it? Impact of Recreational and Medical Marijuana use during Pregnancy and Lactation on the Newborn Moni Snell MSN RN NNP-BC Neonatal Nurse Practitioner NICU Regina Qu’Appelle Health Region Objectives Understand the current use, risks and differences between medical (CBD) and recreational (THC) marijuana Discuss evidence based education for women and current management strategies for caring for newborns exposed to THC through pregnancy and breastfeeding Discuss the impact of increased newborn exposure to recreational and medical marijuana with it’s legalization Marijuana… common term for Recreational Cannabis in the form of dried leaves, stems or seeds Anticipated legalization in Canada July 2018 Currently legal in 29 states in the US Recreational use and self –medication with cannabis is very common • Cannabis: pot, grass, reefer, weed, herb, Mary Jane, or MJ Peak use is in the 20’s and 30’s : women’s • Contains over 700 chemicals, about 70 of reproductive years which are cannabinoids • Hash and hash oil also come from the cannabis plant Cannabis Ingredients Tetrahydrocannabinol (THC) is the chemical that makes people high Cannabidiol (CBD) is known for its medicinal qualities for pain, inflammation, and anxiety o CBD does not make you feel as high Different types of cannabis and effects depend on the amount of THC or CBD, other chemicals and their interactions THC content is known to have increased over the past several decades Oils have higher percentage of THC and THC in edible cannabis products can vary widely and can be potent THC content/potency of THC confiscated by DEA in US has been steadily increasing Consequences could be worse than in the past, especially among new users or in young people with developing brains ElSohly et al, (2016) Changes in cannabis potency over the last 2 decades (1995-2014): Analysis of current data in the United States.
    [Show full text]
  • Maternal Assessment 1
    University of Babylon / College of Nursing University of Babylon College of Nursing MATERNAL ASSESSMENT 1 SUPERVISOR BY : - DR.AMEAN STUDEND NAME: - ZAINAB ALI HUSSEIN ROSSUL HAMZA ALYAA NEMIA The aim of maternal assessment 2 1- to identify the high risk of cases 2- to prevent and treat early complication 3- to ensure from contained risk assessment and provide on going to primary health care 4- educate the mother about physiology of pregnancy and labor and care newborn The procedures of the first visit 3 1- Demographic data ( age – occupation- LMP- EDD- P G A- type of labor – blood group + RH) 2- Family history 3- past history 4 -obstetric history 5 -mensterial history Signs of pregnancy 4 - Breast changes - Nausea & vomiting - Amenorrhea - Frequent urination - Fatigue & uterine enlargement - Line anigra - Melasma - Goodell signs - Hegar signs - Braxton contraction First Trimester 5 * (Subjective symptoms) - Amenorrhoea - Morning sickness - Frequent of micturation - Breast discomfort - Fatigue - breast changes Objective signs 6 - breast changes - abdominal enlargment - pelvic changes * ( THE TESTING FOR DIAGNOSIS OF PREGNANCCY IN FIRST TRIMESTER ( BHCG) AND ( U/S) 7 -gestational sac( 29-35) day of gestation - gastational age to determine by the detecting the following structures - cardiac activity in (6 week) and heart rate at (10 weeks) - embryo growth by 7 weeks Second trimester 8 General examination - Breast changes - Enlargment of lower abdomen - abdomenal examination :- included:- a-inspaction:-
    [Show full text]
  • DRUGGED DRIVING CONFERENCE Poly Drug
    DRUGGED DRIVING CONFERENCE February 1 – 4, 2021 Phoenix, Arizona Poly Drug Use Presented by: Tom Humphrey Department of Public Safety & Dennis Milius Sergeant, Department of Public Safety Distributed by: ARIZONA PROSECUTING ATTORNEYS’ ADVISORY COUNCIL 3838 N. Central Ave, Suite 850 Phoenix, Arizona 85012 ELIZABETH BURTON ORTIZ EXECUTIVE DIRECTOR Poly Drug Use – Drug Combinations Poly Drug Use: When a person ingests drugs from two or more different drug categories. The body will exhibit a combination of effects. Poly Drug cases can be some of the more difficult cases for the DRE to evaluate. Due to the fact that the defendant has multiple drugs in his/her system, however, there may be less jury appeal for the defendant. Accordingly, they may be easier to prosecute. Note: the crime lab may only quantify some or even none of the drugs. At times the lab cannot test for all of the drugs in the system due to insufficient blood or lack of testing methods. In most cases, this should not prevent us from proceeding on the case. Alcohol is a drug. It is the most common drug used in combination with other drugs. Alcohol combined with cannabis/marijuana is currently the most common drug combination we see in Arizona. Potential Effects of Poly Drug Use Four types of combined effects can, and generally will, occur when two or more drug categories are used together: • Null Effect • Overlapping Effect • Additive Effect • Antagonistic Effect Types of Combined Effects Null Effect The simplest way to explain the null effect is using the phrase: "zero + zero = zero" Example: when a subject consumes one drug, which does not cause HGN, and they ingest another drug, which does not cause HGN, then the officer should not expect to see HGN.
    [Show full text]
  • Epidemics of HIV, HCV and Syphilis Infection Among Synthetic Drugs
    www.nature.com/scientificreports OPEN Epidemics of HIV, HCV and syphilis infection among synthetic drugs only users, heroin-only users and Received: 7 November 2017 Accepted: 28 March 2018 poly-drug users in Southwest China Published: xx xx xxxx Shu Su1, Limin Mao 2, Jinxian Zhao3, Liang Chen3, Jun Jing4, Feng Cheng4 & Lei Zhang 1,4,5 The number of poly-drug users who mix use heroin and synthetic drugs (SD) is increasing worldwide. The objective of this study is to measure the risk factors for being infected with hepatitis C (HCV), human immunodefciency virus (HIV) and syphilis among SD-only users, heroin-only users and poly- drug users. A cross-sectional study was conducted in 2015 from a national HIV surveillance site in Southwest China, 447 poly-drug, 526 SD-only and 318 heroin-only users were recruited. Poly-drug users have higher drug-use frequency, higher rates of drug-sharing and unsafe sexual acts than other users (p < 0.05). About a third (36.7%) of poly-drug users experienced sexual arousal due to drug efects, which is higher than the rate among other drug users. Poly-drug users had the highest prevalence of HIV (10.5%) and syphilis (3.6%), but heroin-only users had the highest prevalence of HCV (66.0%) (all p < 0.05) among three groups. Logistic regression shows among poly-drug users, having sex following drug consumption and using drugs ≥1/day were the major risk factors for both HIV (Adjusted odds ratio (AOR) = 2.4, 95% CI [1.8–3.4]; 2.3, [1.6–3.1]) and syphilis infection (AOR = 4.1, [2.1–6.9]; 3.9, [1.8–5.4]).
    [Show full text]
  • Pennsylvania Drug and Alcohol Abuse Control Act."
    § 1690.101. Short title This act shall be known and may be cited as the "Pennsylvania Drug and Alcohol Abuse Control Act." § 1690.102. Definitions (a) The definitions contained and used in the Controlled Substance, Drug, Device and Cosmetic Act shall also apply for the purposes of this act. (b) As used in this act: "CONTROLLED SUBSTANCE" means a drug, substance, or immediate precursor in Schedules I through V of the Controlled Substance, Drug, Device and Cosmetic Act. "COUNCIL" means the Pennsylvania Advisory Council on Drug and Alcohol Abuse established by this act. "COURT" means all courts of the Commonwealth of Pennsylvania, including magistrates and justices of the peace. "DEPARTMENT." The Department of Health. "DRUG" means (i) substances recognized in the official United States Pharmacopeia, or official National Formulary, or any supplement to either of them; and (ii) substances intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in man or other animals; and (iii) substances (other than food) intended to affect the structure or any function of the body of man or other animals; and (iv) substances intended for use as a component of any article specified in clause (i), (ii) or (iii), but not including devices or their components, parts or accessories. "DRUG ABUSER" means any person who uses any controlled substance under circumstances that constitute a violation of the law. "DRUG DEPENDENT PERSON" means a person who is using a drug, controlled substance or alcohol, and who is in a state of psychic or physical dependence, or both, arising from administration of that drug, controlled substance or alcohol on a continuing basis.
    [Show full text]
  • MDMA ('Ecstasy'): a Review of Its Harms and Classification Under the Misuse of Drugs Act 1971
    MDMA (‘ecstasy’): A REVIEW OF ITS HARMS AND CLASSIFICATION UNDER THE MISUSE OF DRUGS ACT 1971 Advisory Council on the Misuse of Drugs ACMD Advisory Council on the Misuse of Drugs 3rd Floor (SW), Seacole Building 2 Marsham Street London SW1P 4DF February 2008 Rt Hon Jacqui Smith MP Home Office 2 Marsham Street London SW1P 4DF Dear Home Secretary, The Advisory Council on the Misuse of Drugs (ACMD) recently considered that a review of MDMA (‘ecstasy’) would be timely as there is a much greater body of evidence regarding the harms and misuse of MDMA since the Council last provided its advice to Ministers in 1996. I have pleasure in enclosing the Council’s report. The use of MDMA is undoubtedly harmful. I would therefore like to emphasise that the Council continues to be concerned about the widespread use of MDMA; particularly among young people. Due to its prevalence of use, MDMA is a significant public health issue and we believe that criminal justice measures will only have limited effect. You will wish to note that the Council strongly advises the promulgation of public health messages. It is of vital importance that issues of classification do not detract from messages concerning public health. Forensic evidence shows that MDMA is by far the most commonly seized of the ‘ecstasy-like’ drugs. MDMA is presently generically classified in Class A under the Misuse of Drugs Act with other ‘ecstasy-like’ drugs. The ACMD has not extended this review to other compounds within the generic classification since their use is considerably less than that of MDMA.
    [Show full text]
  • Best Practice & Research Clinical Obstetrics and Gynaecology
    Author's personal copy Best Practice & Research Clinical Obstetrics and Gynaecology 23 (2009) 809–818 Contents lists available at ScienceDirect Best Practice & Research Clinical Obstetrics and Gynaecology journal homepage: www.elsevier.com/locate/bpobgyn 6 Fetal growth screening by fundal height measurement Kate Morse, Bsc (Hons) DPSM RM RGN, Specialist Midwife, Amanda Williams, MSc Dip HE RM RGN, Specialist Midwife, Jason Gardosi, MD FRCOG FRCSED, Professor * West Midlands Perinatal Institute, Birmingham B6 5RQ, UK Keywords: Fundal height assessment is an inexpensive method for screening fundal height for fetal growth restriction. It has had mixed results in the litera- symphysio-fundal height ture, which is likely to be because of a wide variety of methods customised charts used. A standardised protocol of measurement by tape and plot- ultrasound scan ting on customised charts is presented, which in routine practice fetal biometry has shown to be able to significantly increase detection rates, uterine artery Doppler while reducing unnecessary referral for further investigation. Fundal height measurement needs to be part of a comprehensive protocol and care pathway, which includes serial assessment, referral for ultrasound biometry and additional investigation by Doppler as required. Ó 2009 Published by Elsevier Ltd. The urgency for improving antenatal detection of the small-for-gestation (SGA) or intrauterine growth-restricted (IUGR) baby increases with the awareness that fetal growth restriction is a common precursor of adverse outcome. While we have yet to establish reliable tests to predict which pregnancies are at risk of developing IUGR, surveillance of fetal growth in the third trimester of pregnancy continues to be the mainstay for the assessment of fetal well-being.
    [Show full text]