Screening for other Substance Use in Pregnancy

It is beyond the scope of MOMCARE to provide extensive guidance about non-opioid substance use in pregnancy. However, we provide some basic things to know. 

Image of pills in bottle
Print

Key Points

HOW 

  • Screening for other substance use (non-opioids/alcohol/benzos) in pregnancy should occur either at intake or the full initial health assessment visit.
  • As with screening for opioid use, we do NOT recommend using urine drug tests. Screening should be with validated verbal screens.
  • Here is an adapted, simple question you can ask:
    • “In the past year, have you used any of the following substances? Marijuana, cocaine, methamphetamines, hallucinogens (e.g. LSD, acid, mushrooms, Special K, or ecstasy), prescription stimulants (e.g. Ritalin or Adderal), sedatives/sleeping pills? I’m not asking to get you in trouble, but because it’s important for your health and your baby’s health to know.”
  • There are many, many screening questionnaires to screen for tobacco use. Here is one option:
    • When you are not in jail, what describes your current tobacco use (cigarettes, vaping, e-cigarettes)? Smoke every day, a few times a week, less than that, I quit in the last year, never smoked.
  • If a pregnant patient screens positive for substance use, refer for recovery support services and behavioral treatment. You can discuss the risks of substance use during pregnancy, and why it’s important to be in recovery.
  • If a pregnant patient screens positive for tobacco or nicotine use, discuss the risks of tobacco and nicotine use in pregnancy. Refer the patient for behavioral smoking cessation. Nicotine replacement (e.g. gum, patch) may be appropriate for some pregnant patients.
  •  

WHY

  • Polysubstance use is common, pregnancy is no different.
  • Some substances like methamphetamines, cocaine, marijuana, and tobacco do not have a treatable withdrawal syndrome but should still be identified because they can cause maternal and fetal complications.
  • Screening for other substance use can identify people who would benefit from treatment resources and other social supports as they prepare to parent.


KEEP IN MIND

  • Remember, a drug test is not a parenting test. If someone screens positive, this does not mean they cannot parent, but they should be referred for services. And, being in jail while pregnant doesn’t mean they are a bad parent.
  • The use of other substances in pregnancy warrants referral to behavioral substance use treatment, but the patient must be ready to accept treatment, as well as reentry support.
  • Review the urgent maternal warning signs and educational materials on being pregnant/postpartum with OUD with patients. Educate your patients about these symptoms so they are aware while in jail and in the community. 

Deeper Dive

HOW 

When should screening for other substance use in pregnancy occur?

Screening for other substance use (non-opioids/alcohol/benzos) in pregnancy should occur either at intake or the full initial health assessment visit. Because there is not a dangerous withdrawal syndrome with these other substances, it is okay to defer screening to the full assessment.


How should jail staff screen for other substance use in pregnancy?

As with screening for opioid use, we do NOT recommend using urine drug tests. Screening should be with validated verbal screens.

As with screening for OUD in pregnancy, there are several validated screening questionnaires. NIDA Quick Screen, SURP-P, S-BIRT, 4P’s Plus, CRAFT, Wayne Indirect Drug Use Screener, DAST-10. Here is an adapted, simple question you can ask:

  • “In the past year, have you used any of the following substances? Marijuana, cocaine, methamphetamines, hallucinogens (e.g. LSD, acid, mushrooms, Special K, or ecstasy), prescription stimulants (e.g. Ritalin or Adderal), sedatives/sleeping pills? I’m not asking to get you in trouble, but because it’s important for your health and your baby’s health to know.”

There are many, many screening questionnaires to screen for tobacco use. Here is one option:

  • When you are not in jail, what describes your current tobacco use (cigarettes, vaping, e-cigarettes)? Smoke every day, a few times a week, less than that, I quit in the last year, never smoked.


What should be done if a pregnant patient screens positive for other substance use? 

Refer them for recovery support services and behavioral treatment. You can discuss the risks of substance use during pregnancy, and why it’s important to be in recovery, but avoid language that blames them for harming the fetus. Use a compassionate approach as you refer them to services, acknowledging that recovery is a long and difficult process.


What should be done if a pregnant patient screens positive for tobacco or nicotine use?

Discuss the risks of tobacco and nicotine use in pregnancy. Refer the patient for behavioral smoking cessation programs as you would for non-pregnant patients, either in jail or upon return to the community. Nicotine replacement (e.g. gum, patch) may be appropriate for some pregnant patients. See this guidance from the American College of Ob/Gyn’s (ACOG) for more information about treatment.


WHY

Why is it important to screen pregnant patients for other substances?

Many pregnant people who use opioids use other substances as well—alcohol, benzos, methamphetamines, cocaine, marijuana, tobacco, and others.

While only opioids, alcohol, and benzos have a treatable withdrawal syndrome when someone stops using them, other substance use in pregnancy can cause maternal or fetal complications. For example:

  • Smoking in pregnancy is associated with miscarriage, preterm birth, low birth weight, and, after birth, sudden infant death syndrome (SIDS), and other medical problems during childhood.
  • Cocaine and methamphetamine use in pregnancy can cause similar problems, and can also lead to preterm birth, hemorrhage, and fetal or maternal death.

Screening for other substance use can identify people who would benefit from treatment resources and other social supports as they prepare to parent.

Resources