Contraceptive use and pregnancy outcomes among opioid drug-using women: a retrospective cohort study.
OBJECTIVE
The contraceptive needs of illicit opioid users differ from non-drug users but are poorly understood. The aim of this study was to describe contraceptive use and pregnancy outcomes in opioid-using women, and to examine their association with a range of risk factors.


METHODS
This retrospective cohort study used UK general practice records, Treatment Outcomes Profile and National Drug Treatment Monitoring System data, and a nested data validation exercise. A cohort of 376 women aged 20-61 years were in active treatment for opioid addiction in October 2010 at two specialised primary care practices in North-East England. Outcomes were age-adjusted prevalence estimates for contraceptive use and pregnancy outcomes in users of illicit opioids. The association between lifestyle-related risk factors and contraception was explored.


RESULTS
Drug-using women made lower use of planned (non-condom) contraception (24% vs 50%, p<0.001), had more frequent pregnancy terminations (0.46 vs. 0.025, p = 0.004) and higher annual incidence of chlamydia (1.1% vs. 0.33%, p<0.001), when compared with age-matched population data. Specifically, there was low use of oral contraceptives (4% vs. 25%, p<0.001), IUCD (1% vs. 6%, p<0.001), and sterilisation (7% vs. 6%, p = 0.053), but higher rates of injectable contraceptives (6% vs. 3%, p = 0.003). A total of 64% of children aged <16 years born to this group did not live with their mother. No individual risk factor (such as sex-working) significantly explained the lower use or type of non-condom contraception.


CONCLUSIONS
This is the first study to describe planned contraceptive use among drug-users, as well as the association with a range of risk factors and pregnancy outcomes. The low uptake of planned contraception, set against high rates of terminations and sexually transmitted disease demonstrates the urgent clinical need to improve contraceptive services, informed by qualitative work to explore the values and beliefs influencing low contraceptive uptake.
Fulcrum Medical Practice, Acklam Road, Middlesbrough, England.
Charles S
CS
Cornford
School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, England.
Helen J
HJ
Close
Clinical Blood Sciences, Jenner Wing, St Georges Hospital, Blackshaw Road, Tooting, London,England.
Roz
R
Bray
Northern Region Gender Dysphoria Service, Benfield House, Walkergate Park, Benfield Road, Newcastle upon Tyne, England.
Deborah
D
Beere
School of Medicine, Pharmacy and Health, Wolfson Research Institute, Durham University, Stockton-on-Tees, England.
James M
JM
Mason
D000328:Adult; D003267:Contraception / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies