Scoping review: mapping clinical guidelines and policy documents that address the needs of women who are dependent on drugs during the perinatal period.

BACKGROUND: Women who use or are in treatment for drug use during the perinatal period often have complex needs and presenting comorbidity. Women who use opioids during pregnancy, and their infants, experience poor outcomes. Drug use by women during pregnancy is a public health priority. This scoping review aimed to (1) map clinical guidelines, treatment protocols and good practice guidance across the UK for women who use or are in treatment for drug use during the perinatal period, (2) identify recommended best practice across health and social care for optimising outcomes and reducing inequalities for these women and (3) identify potential gaps within guidance. METHODS: We followed the Joanna Briggs International (JBI) guidance on scoping reviews and PRISMA Scr extension. A registered protocol, containing a clear search strategy, inclusion, and exclusion criteria was adhered to. Reviewers double screened 25%, discussing disagreements. Data were extracted using a predefined template and charted in tables. Recommendations for best practice were organised around agreed categories. RESULTS: Of 968 documents screened, 111 met the inclusion criteria. The documents included UK-wide, national, regional, and organisational policy documents. They varied in the degree they were relevant to women who use or are in treatment for drug use during the perinatal period, the settings to which they applied, and their intended users. Most were created without patient or public involvement and lacked any clear evidence base. Overall, documents recommended an integrated model of care with a lead professional, clear referral pathways and information sharing between agencies. Guidance suggested referrals should be made to specialist midwives, drug, and social care services. A holistic assessment, inclusive of fathers / partners was suggested. Recent documents advocated a trauma-informed care approach. Opioid substitution therapy (OST) was recommended throughout pregnancy where required. Potential gaps were identified around provision of support for women postnatally, especially when their baby is removed from their care. CONCLUSIONS: This synthesis of recommended practice provides key information for practitioners, service providers and policy makers. It also highlights the need for guidelines to be evidence-based, informed by the experiences of women who use or are in treatment for drug use during the perinatal period, and to address the support needs of postnatal women who have their babies removed from their care.

Non-Prescribed Substance Use during the First Month of Treatment by People Receiving Depot Buprenorphine for Opioid Use Disorder.

Background: Non-prescribed substance use (NPSU) during the treatment of opioid use disorder (OUD) is a recognized phenomenon. The use of non-prescribed substances is associated with discontinuing treatment and drop-out can occur within the early weeks of treatment, before benefit from treatment occurs. Recent developments in treatment include long-acting, slow-release depot buprenorphine injections. This article focuses on NPSU during the first month of treatment with depot buprenorphine, addressing the frequency with which it occurs, the substances used, and reasons for use. Methods: 70 semi-structured interviews (held at three time-points) were conducted with 26 patients initiating depot buprenorphine as part of a longitudinal qualitative study. Analysis prioritized content and framework analyses. Findings: 17/26 participants self-reported NPSU at various times during the first month of treatment. NPSU typically involved heroin, crack-cocaine and some use of benzodiazepines and/or cannabis. Participants' reasons for heroin use were connected to their subjective accounts of opioid withdrawal symptoms, the management of pain, and experimentation (to test the blockade effect of buprenorphine). Frequency of heroin use was typically episodic rather than sustained. Participants associated crack-cocaine use with stimulant-craving and social connections, and considered their use of this substance to be difficult to manage. Conclusions: Patients' initial engagement with treatment for OUD is rarely examined in qualitative research. This study highlights how NPSU amongst patients receiving new forms of such treatment continues to be a challenge. As such, shared decision-making (between providers and patients) regarding treatment goals and NPSU should be central to the delivery of depot buprenorphine treatment programmes.

Challenges in delivering personalised support to people with multiple and complex needs: qualitative study.

Personalisation involves placing service users at the centre of service provision to ensure that the support they receive meets their individual needs, hopes and goals. This paper focuses on a programme delivering personalised support to people with multiple and complex needs ('beneficiaries'). Each beneficiary received a tailored package of support and a £12,000 personal budget. Despite being well-resourced, the programme struggled to recruit and retain beneficiaries. The aim of this paper is to identify the challenges encountered and to share learning. Repeat semi-structured interviews (n = 56) were conducted with beneficiaries, programme workers and external partners. Interviews were audio recorded, transcribed, coded and analysed via Iterative Categorization. Five categories of challenge were identified: 1. poor understanding of the programme; 2. the characteristics and needs of beneficiaries and programme workers; 3. lack of clarity regarding who owned and controlled the budget; 4. strained interprofessional relationships; and 5. excessive bureaucracy combined with difficulties establishing programme outcomes. Findings illustrate how the delivery of person-centred support is compromised by interacting individual, organisational, and system level factors, particularly poor interprofessional collaboration. The data also suggest that personal budgets may undermine personalisation for people with multiple and complex needs.

Comparisons of self-report data and oral fluid testing in detecting drug use amongst new treatment clients.

Drug testing is widely used and employed in diverse contexts, including drug treatment clinics. Building on previous research, this paper aims to (i) compare self-report data and oral fluid (OMT) testing in detecting drug use amongst individuals beginning a new episode of drug treatment and (ii) identify factors that may predict drug users who have discordant self-report and OMT test results. Two hundred and seventy-one new drug treatment clients completed a structured questionnaire that included questions relating to drug use during the preceding 3 days and provided an oral fluid sample that was independently tested for opiates, benzodiazepines, methadone and cannabis. Data were analysed using kappa statistics (Cohen, 1960) and univariate and multivariate logistic regression. Findings indicated a high level of consistency between self-reported drug use and OMT testing. However, agreement varied by drug type and respondents commonly reported consumption that screening failed to identify. Inconsistencies appeared to relate to a number of factors and were not necessarily a function of deliberate distortion by the drug user. Overall, it is concluded that OMT testing is a good indicator of the validity and reliability of drug users' self-report data. Nonetheless, its accuracy might be greater for some drug categories than for others. Equally, further study comparing test results and self-reported drug use amongst different populations and in different contexts is required.