25 September 2012 Early Years Pathfinder. misuse. Insert name of presentation on Master Slide. Presenter: Dr Sarah J Jones

Transcription

1 25 September 2012 Early Years Pathfinder Project Substance misuse Insert name of presentation on Master Slide Presenter: Dr Sarah J Jones

2 Presentation aim To present the findings of the review Background and evidence base Epidemiology Effective interventions to screen for / reduce substance misuse Current service provision / practice Early years pathfinder project:-

3 Includes Recreational drugs Misuse of OTC medication Misuse of prescription medication Misuse of alcohol Misuse of volatile substances Excludes Caffeine (energy drinks, tea, coffee, cola) Tobacco

4 Terminology, abuse Alcohol +/- drugs Drugs +/- alcohol Recreational, OTC, prescription Alcohol is legal Government says it s safe Drugs legal or illegal

5 Alcohol and pregnancy Alcohol passes freely across the placenta What happens next? May include miscarriage, still birth, LBW, learning disability, hyperactivity, FASD

6 Confused? House of Commons Science and Technology committee There is no evidence for a level of risk free drinking during pregnancy Drinking one or two units once or twice per week has not been shown to be harmful Both statements believed to be equally probable

7 UK CMOs Pregnant women should avoid alcohol But, if they do choose to drink they should not drink more than 1 or 2 units of alcohol once or twice a week Should not get drunk

8 NICE No drinking during the first 3 months of pregnancy Getting drunk or binge drinking may be harmful (5+ standard drinks or 7.5 UK units) DH 6+ UK units is a binge

9 Is it us? drink in moderation Moderation? Standard drink? Daily guidelines Weekly guidelines Just 7 times daily Account for alcohol free days Daily and weekly

10 International variations 57 countries 27 have drinking guidelines in terms of grams of ethanol 145 countries specify limits on alcohol while driving 14 countries publish guidelines on drinking during pregnancy Don t do it

11 International variations (2) Minimum legal drinking age UK, and much of world, 18 USA 21 (state to state variations) Germany, Poland, Greece, Norway, Portugal, Spain 16 Exemptions for drinking at home with parents

12 What s a unit? G alcohol Not stated Countries Mexico, Austria, Czech Republic, Kenya, Norway 8 UK 10 Ireland, Estonia, Poland, Switzerland, Brazil, Bulgaria, France, Netherlands, New Zealand, Singapore, Spain, Australia, Portugal, Hong Kong, Slovenia, Lithuania 12 Italy, South Africa, Germany, Iceland, Finland, Denmark, Sweden Canada 14 USA, Slovakia

13 Daily consumption guidelines Males Females Countries 4 3 USA, Ireland, UK 4 2 Estonia, Poland, Switzerland 3 2 Italy, South Africa, Brazil, Bulgaria, France, Netherlands, New Zealand, Singapore, Spain, Canada 2 2 Australia, Portugal 2 1 Slovakia, Germany, Iceland, Hong Kong, Slovenia Finland

14 Based on a 10g unit (daily consumption) Men 2 Women R- Men R-Women 1 0

15 Alcohol consumption during pregnancy Little / no UK data Australia 59% preg / bf women using alcohol Sweden 15% in first 6 wks preg, 30% rest USA 9-15% preg, 2-4% binge Denmark 10-25% binge, 50% binged in pre-preg recognition

16 Biases Unit confusion Recall bias Reporting bias Response bias

17 Drug guidelines? OTC and prescription Presumption illegal drugs are illegal therefore any consumption is harmful? NICE direct effects of cannabis are uncertain but it may be harmful... because it is often associated with smoking

18 Drug misuse during pregnancy - UK Cannabis use -8.5 to 14.5% of women by 12 weeks Opiates 2% Cocaine 11% 1.1%

19 Drug misuse during pregnancy - world USA 4.3 to 5.5% 1.6 to 7.2% opiates to 95% 9.5% cocaine Cocaine use strongly linked to other drugs Australia 6% Worldwide - Cannabis 1.8 to 27%

20 Outcomes of alcohol misuse Pregnancy Miscarriage? Brain, neurological development? Pre-term labour high consumption Still birth low consumption Poor attendance for antenatal care

21 Outcomes of alcohol misuse (2) FASD Existence still debated in UK Diagnosed years after birth Recording poor SIDS Acute myeloid leukaemia

22 Outcomes of drug misuse Poor antenatal care STDs Placental abruption, miscarriage, prematurity, still birth, IUGR US data Polydrug use common, lack of adjustment for confounders

23 Policy context Working together th to reduce harm Highlights harmful consumption of alcohol Not pregnancy / EY specific All Wales Maternity record National screening committee No screening recommended in relation to alcohol misuse

24 PEDW data - P04.3, P04.4, P04.9 Primary Time period n Bed days diagnosis P to to 2011 <5 5 P to 2011 <5 17 to 108 (Annual average) (annual 3 yr average range) P to 2011 <5 Any diagnosis P

25 P withdrawal Admi issions Bed days Admissions Bed Days 0 0

26 Q86 and P Num mber of hospital admissio ons Any mention of Primary diagnosis

27 Infant feeding survey 6 to 10wk olds 100% 90% 80% 70% 60% 15+ units 50% 8-14 units 40% 3-7 units 30% 1-2 units 20% 10% Less than 1 unit 0% Did not drink

28 Drinking behaviour and ses Drank before pregnancy Drank during pregnancy 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% % 60 Managerial and Routine and professional Intermediat te occupations manual Never worked Unclassified All No change / drank more Drank less Gave up drinking Managerial professio l and nal Intermediate occupations Routine and manual Never worked Unclassified All

29 Drinking behaviour and age 100 Drank before pregnancy 70 Drank during 60 pregnancy % 30 90% 20 80% 10 70% No change / 0 60% drank more % Under All 50% 40% 30% 20% 10% 0% Drank less Gave up drinking Under l All

30 Evidence - screening Mainly for alcohol l No consensus, no optimum tool AUDIT-C TWEAK and T-ACE also effective

31 Evidence - interventions Alcohol No psychological interventions No pharmacological interventions Primary prevention Education, warning labels, alcohol ban Poor to fair quality studies Secondary yprevention Poor to fair quality studies

32 Evidence interventions (2) Drugs Psychosocial interventions have some effect on reducing drug use No evidence to support MI Pharmacological intervention had no significant differences between drugs compared

33 Evidence interventions (3) Integrated programmes (physical, social and mental health needs) no more effective than non-integrated Home visits it have no good evidence of effect Alternative ante-natal care models have no good evidence of effect

34 Current service provision specialist midwives Focus appears to be on drugs and safe guarding More needed on alcohol?

35 Conclusions International variations in definitions of units, moderate drinking and binge drinking need to be addressed d Dose response relationship unclear Alcohol Drug misuse Prevalence of substance misuse during pre-pregnancy, p pregnancy, EY unknown

36 Conclusions (2) Some screening tools available Lack of good evidence of effectiveness of intervention Current service focus on drugs and safe-guarding

37 Recommendations Increase focus on alcohol WG Working together to reduce harm h the harmful use of alcohol lis far more widespread than that of drugs Train health care professionals to deliver ABI Consistent messages How to collect data and obtain more robust research evidence?