Drug use and pregnancy – challenges for public health

Summary

Problem drug use (defined by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) as “injecting drug use or long duration/regular use of opioids, cocaine and/or amphetamines” [1]) and pregnancy affect a sizeable population in Europe. It is estimated that there are about 1.3-1.7 million problem opioid users in the European Union and Norway [2]. Furthermore, approximately 20% of drug users entering drug treatment and around 34% of opioid users are women (the great majority of whom are of childbearing age) [3], and every year, as many as 6.5-11% of female problem drug users may get pregnant or give birth [4,5]. This suggests that each year there may be as many as 30.000 pregnant women using opioids in Europe, and the number of pregnant women using drugs other than opioids may be equally high. The issue of pregnancy and drug use is important to address because of the associated personal and public health challenges regarding both the mother and the unborn child, especially regarding infections that are common among drug-using populations. In this article, we review some of these challenges: infection with blood-borne and sexually transmitted diseases (STIs, including infections with human immunodeficiency virus (HIV) and hepatitis C virus (HCV), dual diagnosis (substance use combined with mental illness), social and personal welfare and drug treatment,; and assess and summarise possible solutions to alleviate these challenges.