Towards a Dynamic Model of Methamphetamine use During Pregnancy: Where did the current surge in drug

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Towards a Dynamic Model of Methamphetamine use
During Pregnancy Where did the current surge in
drug treatment admissions come from?

• Global Conference on Methamphetamine
• Prague 2008
• Mishka Terplan MD MPH
• University of Chicago, OB/Gyn

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Pregnancy A Window of Opportunity

• Pregnancy time of biological and social
  transformation
• Time to think about the future
• Desire to be a good parent
• Come into contact with social agencies

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• Methamphetamine is the number one drug of use for
  pregnant drug treatment admissions in the US
• Where did this come from?
• Main Goal piece together epidemiology of meth
  in pregnancy
• Secondary Goal examine the interstices of
  different national-level data sets their
  confluence, conflict, and omission

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Towards a Dynamic Model of Methamphetamine use
During PregnancyData Sources

• National Survey of Drug Use and Health (NSDUH)
• Weighted sample
• Telephone/CASI survey
• Uniform since 2002
• Approximately 24,000 reproductive age women
  surveyed each year
• Limitations
• Only households
• No prisons
• No inpatient treatment
• No homeless
• Underreporting

• Treatment Episode Data Set (TEDS)
• Census of treatment admissions
• Since 1994 uniform reporting
• Captures 80 of all admissions in US
• Limitations
• Unit of analysis is treatment admission not
  individual
• Captures only treatment facilities receiving
  government funding

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Primary Drug amongPregnant Drug Treatment
Admissions US
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Treatment Admissions for Reproductive Age Men
Women TEDS 2006
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Characteristics of pregnant meth admissions 2006
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Where did the rise in pregnant meth treatment
admissions come from?

• Pregnant women who use meth are women who use
  meth, get pregnant, and dont stop using meth
• In order to construct a dynamic model, need to
  look at two dimensions
• 1 background meth rate
  (women
  of reproductive age)
• 2 natural history of meth consumption in
  pregnancy (how pregnancy leads to
  changes in use patterns)

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The background rateDrug use among women
NSDUH
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The background rateIllicit drug use among women
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The background rateMeth use among women
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Most common drugs in pregnancy
NSDUH
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The background rateMeth use in pregnancy
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How do pregnant meth users differ from
non-pregnant meth users? (NSDUH 2002-6)
NSDUH Average 2002 - 2006
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How do pregnant meth users differ from
non-pregnant meth users? (cont)
NSDUH Average 2002 - 2006
percentages reports out of those needing
treatment for any substance
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The natural history of meth in pregnancy
plt0.05
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Demographic Characteristics of Pregnant women
using (NSDUH) and in treatment (TEDS) for Meth
Teds proportions adjusted for race, age,
education, employment status, insurance and
marital status
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Where did the current surge in drug treatment
admissions come from?

• From 1994 to 2006 pregnant meth admissions rose
  from 1502 to 5312
• Since 2004 meth is the most common substance
  leading to treatment admissions in US

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Where did the current surge in drug treatment
admissions come from?

• Hypothesis
• Drug treatment admissions are the tip of the
  iceberg there has been a similar rise in use
  in the general population
• Evidence
• Probable rise in mid 1990s among women, no change
  in preg

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Where did the current surge in drug treatment
admissions come from?

• Hypothesis
• Overall there are more treatment requests
• Evidence
• Sort of

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Where did the current surge in drug treatment
admissions come from?

• Hypothesis
• Pregnant women are more likely to enter treatment
• Evidence
• Difficult to assess from the data weighted
  samples for pregnant and meth using are unstable

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Ratio of meth treatment admissions to treatment
requests in pregnancy
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Where did the current surge in drug treatment
admissions come from?

• Hypothesis
• Pregnant women are more likely to need treatment
• Evidence
• Yes

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Where did the current surge in drug treatment
admissions come from?

• Hypothesis
• Pregnant women more likely to get treatment
  (access)
• Evidence
• Treatment need is greater in pregnancy, but
  receipt is similar between the groups

P0.2
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Conclusion

• Meth is the most common drug of use among
  pregnant drug treatment admissions, however one
  of the lesser used substances in pregnancy from
  survey data
• Women who use meth decrease use during pregnancy
• Women who continue to use meth in pregnancy are
  more likely to meet criteria for substance
  abuse/dependence
• Therefore preg women more likely to need
  treatment
• However as likely as non-preg to receive
  treatment
• Those who receive treatment older, whiter, more
  marginalized

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Conclusion

• In spite of centralized data collection system in
  US
• Data sets dont align well
• Dont allow linkages
• Even though considered the gold standard NSDUH
  not a reliable source for trend data from
  hidden or stigmatized populations (i.e.
  pregnant drug users)

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• Special thanks to Erica Smith
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