title: Impact of drug market changes on substance-using pregnant women in three key Sydney drug markets.
abstract: BACKGROUND
  In 2001 the supply of heroin was substantially reduced across Australia. Given the child protection concerns associated with the use of substances by pregnant women, it was pertinent to examine how the reduction in the supply of heroin affected this community of users. This paper aimed to assess the extent of any drug-related problems among pregnant women associated with the reduction in heroin supply in New South Wales (NSW).
  
  
  METHODS
  Two sources of data were used: (1) Data on hospital visits in NSW in which drug and alcohol problems were noted as complicating the pregnancy; and (2) Key informant reports from services targeting substance-using pregnant women across the three main Sydney drug markets.
  
  
  RESULTS
  The shortage did not affect the number of hospital separations for substance-using pregnant women, nor the number of women referred to services for substance use in pregnancy. Key informants reported an increase in the use of cocaine among pregnant women and a change in injection sites for some women (including into breast tissue). No substantial change in adverse outcomes was observed to be associated with this change in patterns of drug use.
  
  
  CONCLUSIONS
  The reduction in heroin supply appeared to have limited impact on the number of substance-using pregnant women as assessed by hospital episodes and key informant reports. The evidence suggested an increase in the injecting of cocaine by pregnant women using drug treatment services, similar to the changes in drug use patterns observed among other groups of injecting drug users. The lack of change observed in the qualitative and statistical data regarding adverse health consequences associated with cocaine injecting suggests the potentially negative impact of maternal cocaine use on infant health may be difficult to detect and monitor.
authors: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NS, 2052, Australia. e.conroy@unsw.edu.au
authors: Elizabeth
authors: E
authors: Conroy
authors: Louisa
authors: L
authors: Degenhardt
authors: Carolyn
authors: C
authors: Day
mesh_terms: D000328:Adult; D001294:Attitude to Health; D062787:Drug Overdose / Q000453:epidemiology; D005260:Female; D006266:Health Education / Q000458:organization & administration; D003932:Heroin / Q000600:supply & distribution*; D006556:Heroin Dependence / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D013287:Illicit Drugs / Q000600:supply & distribution*; D008425:Maternal Behavior; D009294:Narcotics / Q000600:supply & distribution; D009517:New South Wales / Q000453:epidemiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000517:prevention & control; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000517:prevention & control; D011795:Surveys and Questionnaires
chemical_list: D013287:Illicit Drugs; D009294:Narcotics; D003932:Heroin