Changing patterns of heroin and crack use during pregnancy and beyond

The publication of Hidden Harm [Advisory Counsil on the Misuse of Drugs (ACMD), 2003] was an attempt to increase awareness of the risks to children of parental drug use, and the need for a coherent response across services to this issue, both during pregnancy and after the child has been born. The current study examined a cohort of drug-using mothers who had accessed a specialist 'mother and baby' drug treatment service at some point during their pregnancy or in the period immediately after the birth of the child, assessing both their experiences of drug treatment and maternity services and the changes in their drug use. Using a lifetime history instrument ( the Lifetime Drug Use History), the study showed reductions in quantity and frequency of heroin use over the course of pregnancy ( particularly after month six of pregnancy and in the month after the birth). Although crack use is reduced, there was a less consistent pattern of change. Stigma was reported by some participants with greater dissatisfaction with maternity ( and to a lesser extent drug services) linked to higher levels of heroin and crack use. Nonetheless, the study shows that pregnancy is a period of change in the lives of drug using mothers and an opportunity for lasting transitions in the trajectory of the heroin using career.