MAY 2017 SUBSTANCE USE IN PREGNANCY Prepared By: Aaron Fields, MD University of Rochester Medical Center, NYS Maternal & Infant Health Center of Excellence 265 Crittenden Blvd, Rochester, NY 14642 – Tel: 585-276-7893 – Fax: 585-461-4532 [email protected] – www.mihcoe.org Introduction ..............................................................................................................................................................2 What is Addiction? .....................................................................................................................................................3 Drugs of Abuse ..........................................................................................................................................................4 Opioids ................................................................................................................................................................................ 4 Stimulants ........................................................................................................................................................................... 4 Nicotine............................................................................................................................................................................... 5 Alcohol ................................................................................................................................................................................ 6 Marijuana ............................................................................................................................................................................ 8 Sedative-Hypnotics ............................................................................................................................................................. 9 Hallucinogens.................................................................................................................................................................... 10 Inhalants ........................................................................................................................................................................... 10 Rates of Drug Use .................................................................................................................................................... 11 Opioids .............................................................................................................................................................................. 11 Stimulants ......................................................................................................................................................................... 12 Nicotine............................................................................................................................................................................. 12 Alcohol .............................................................................................................................................................................. 13 Marijuana .......................................................................................................................................................................... 13 Sedative/Hypnotics ........................................................................................................................................................... 14 Hallucinogens.................................................................................................................................................................... 14 Inhalants ........................................................................................................................................................................... 15 Effects of Drug Use During Pregnancy ....................................................................................................................... 16 Opioids .............................................................................................................................................................................. 16 Stimulants ......................................................................................................................................................................... 16 Nicotine............................................................................................................................................................................. 17 Alcohol .............................................................................................................................................................................. 17 Marijuana .......................................................................................................................................................................... 17 Sedative/Hypnotics ........................................................................................................................................................... 17 Hallucinogens.................................................................................................................................................................... 18 Inhalants ........................................................................................................................................................................... 18 SBIRT for Drug Use ................................................................................................................................................... 19 What is SBIRT? .................................................................................................................................................................. 19 Screening Tools ................................................................................................................................................................. 19 Signs and Symptoms of Addiction .................................................................................................................................... 20 Brief Interventions ............................................................................................................................................................ 21 Referral to Treatment ....................................................................................................................................................... 24 Mandatory Reporters ....................................................................................................................................................... 25 References ............................................................................................................................................................... 26 Appendix A: National Organizations Definitions of Addiction .................................................................................... 31 American Society of Addiction Medicine (ASAM) ............................................................................................................ 31 The National Institute on Drug Abuse (NIDA) .................................................................................................................. 31 Appendix B: Screening Tools .................................................................................................................................... 32 AUDIT-C ............................................................................................................................................................................ 32 NIDA Quick Screen ........................................................................................................................................................... 33 CRAFFT ............................................................................................................................................................................. 40 Introduction Although the opioid epidemic has become a popular topic of conversation in political and public policy arenas, many in the healthcare system have known for years that there was an impending tidal wave of people dependent on opioids and other drugs, which were preventing them from fully engaging as contributing members of society. The fields of Addiction Medicine and Addiction Psychiatry have been present in one form or another in the United States since the latter half of the 18th century. It wasn’t until the 1950s and 1960s that physicians specializing in addiction began to organize. Thanks to the efforts of those pioneers of addiction treatment during the 1950s and 1960s, by the 1980s, the wider medical establishment was beginning to acknowledge the importance of specialized addiction treatment.1 The purpose of this report is to summarize the current body of information and evidence regarding drug addiction during pregnancy. This report begins with a description of what addiction is and how it occurs. This is followed by a synopsis of what many of the more commonly abused categories of drugs are, and some basics about how these drugs cause their effects. Next, an overview of the rates at which the different categories of drugs are abused in the United States and among pregnant women (when such data is available), and the effects these drugs have on a developing fetus/infant and on the mother. Finally, the report concludes with an introduction