Specialized drug liaison midwife services for pregnant opioid dependent women in Dublin, Ireland.

The health needs of pregnant opioid dependent women are increasingly being recognized by health care professionals. These women generally receive limited antenatal care. Maternal and neonatal outcomes are also poorer compared to non-drug using women. The number of pregnant opioid dependent women accessing drug treatment services in the Irish Republic has increased. A specialist Drug Liaison Midwife service was created in March 1999 to liase between the three Dublin Maternity hospitals and the Drug Treatment Services. This paper surveys the first year of operation of one of these posts. It documents socio-demographic background, substance use, and medical histories of these women in addition to maternal and neonatal outcomes. Higher maternal methadone dose was associated with an increased risk of neonatal withdrawals among these women. The experience of this specialist liaison service indicates that it is possible to build effective working relationships between opioid dependent pregnant women and the Obstetric and Drug services involved in their care

Drug liaison midwives.

This letter is in response to an article by Fischer (Addiction 95, pp. 1141-1144) on treatment of opioid dependence in pregnant women. The authors describe the experiences of opiate-dependent pregnant women in Ireland and the creation of a Drug Liaison Midwife (DLM) post at each of the maternity hospitals in Dublin in 1999. Pregnant women are prioritised in terms of treatment access, both outpatient and inpatient, with partners also offered treatment. Methadone maintenance is most commonly used. The paper notes that the appointment of DLMs has improved communication between the obstetric firms and the local drug teams as well as improving services to the patients

What are the risk factors for soft tissue abscess development among injecting drug users?

Background: Much research has been conducted on the risk taking behaviour of injecting drug users. Cutaneous or subcutaneous skin and soft tissue abscesses are common complications of intravenous drug use. Aim: To identify the risk factors to which injecting drug users expose themselves to improve initial assessment. Method: A convenience sampling method was used, and structured interviews were carried out with 70 injecting drug users attending a methadone treatment setting in Dublin. Results and discussion: Forty eight (69%) of participants have had an abscess at some stage. Poor levels of skin cleansing were identified as a main cause, and 80% admitted to sharing injecting equipment. Conclusion: Healthcare professionals need to develop better strategies for delivering safety messages to clients about safer injecting behaviour

Bloodborne virus infections among drug users in Ireland: a retrospective cross-sectional survey of screening, prevalence, incidence and hepatitis B immunisation uptake.

BACKGROUND: Injecting drug users are at high-risk of bloodborne virus infections including hepatitis C (HCV), hepatitis B (HBV) and HIV. AIMS: To document screening for and immunisation against bloodborne viruses and to determine the known prevalence and incidence of these infections. METHODS: A cross-sectional survey of clients attending 21 specialist addiction treatment clinics in one health board area in greater Dublin. Data collected on demographic characteristics, serology for HCV, HBV and HIV and immunisation against HBV. RESULTS: A total of 316 (88%) had been tested for anti-HCV antibody, 244 (68%) had been tested for anti hepatitis B core antibody (anti-HBc), 299 (84%) had been tested for hepatitis B surface antigen (HBsAg) and 307 (86%) had been tested for anti-HIV antibody. The prevalence of anti-HCV, anti-HBc, HBsAg, and anti-HIV were: 66%, 17%, 2% and 11% respectively. The incidence of HCV, HBV and HIV infections were: 24.5, 9.0 and 3.4 per hundred person years respectively. Eighty-one per cent of those in whom it was indicated, had started a targeted HBV immunisation programme in the clinics. CONCLUSION: The proportion of clients screened for HCV, HBV and HIV infection has increased since the introduction of a screening protocol in 1998. Targeted vaccination for opiate users against hepatitis B is more successful than previously shown in Ireland. The prevalence and incidence of bloodborne viruses remains high among opiate users attending addiction treatment services, despite an increase in availability of harm reduction interventions

Drug use in pregnancy: challenges for health care workers.

A comparative study to examine maternal and neonatal outcomes of pregnant women from a case load of a Drug Liaison Midwife (DLM) over a six year period, 2002-2007, compared with a similar study carried out in 1999 (Scully et al 2004) in the same locality, Coombe Women and Infants University Hospital, Dublin (CWIUH). In this study, 436 women met the inclusion criteria. All women were engaged with the DLM and obstetric services. This research compared and contrasted the pattern of drugs used, methadone dosage, obstetrical attendance and neonatal outcome in this group of women. The majority of women were stable in their drug use, attended adequate antenatal care and had a positive neonatal outcome. Results illustrate the importance of a good partnership approach to improving the care for pregnant opiate-dependent women.

Exploring the health concerns of people taking methadone.

This article reports on a study to uncover the health concerns of clients attending a methadone maintenance programme provided by an addiction service in Ireland. The Health Concerns Questionnaire 3 was completed by 261 clients attending methadone maintenance clinics. The most endorsed items tended to be psychosocial health concerns, particularly mood-related items. Additional comments highlighted various health issues including hepatitis C, diet, and sexual and mental health. Clients on methadone maintenance demonstrated a high level of health-related concerns. In particular, they were most concerned about mood and hepatitis C; these topics therefore merit attention from staff in addiction services. (C)2008 Nursing Time

Problem alcohol use among problem drug users : development of clinical guidelines for general practice

Abstract for presentation at AUDGPI Annual Scientific Meeting, Dublin, Ireland, 9th March 2012Introduction: Problem alcohol use is common and associated with considerable adverse health and social outcomes among patients who attend GPs in Ireland and other European countries for opioid substitution treatment. This paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among current or former opioid users attending general practice for methadone treatment. Methods: The guidelines were developed in several stages: i) identification of key stakeholders; ii) development of evidence-based draft guidelines, and iii)determination of a modified ‘Delphi-facilitated’ consensus among the group members. These guidelines were informed by a review of scientific evidence and a qualitative study, results of which will be presented also at this conference. Results: The guidelines incorporate advice for GPs on all aspects of care of this problem, including i) definition of problem alcohol use among problem drug users, ii) screening / identification of problem alcohol use, iii) interventions for treatment and management of problem alcohol use, iv) referral to secondary services and v) role of GPs in the management of persistent problem alcohol use and on-going care. Conclusions: General practice has an important role to play in the care of problem alcohol use among problem drug users, especially patients who attend for methadone treatment. Further research on strategies to inform the implementation of this study is a priority.Health Research Boardau, ti, ke - TS 24.04.1