SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Don't forget contraception when starting treatment (Mar 2009)

Elizabeth walked into my room with a broad grin on her face and said "I thought I would help you this time"! She went on to explain that she had decided to try for her second child. We laughed remembering the story of her first pregnancy.

Almost seven years ago, Elizabeth had arrived at the surgery in a terrible mess. She was thin and drawn, had multiple new and old track marks and a large abscess on her left arm. She was "Miss Angry" - and in a broad Dublin accent that I struggled to understand, Elizabeth said that we had better help her or she would be done for. She went on to say she was injecting 2 grams of heroin daily and her source, her partner, had just been arrested leaving her without money or drugs. We treated the abscess and started her on methadone titration. Within six weeks she described herself as a new woman! Elizabeth had put on about three-quarters of a stone in weight, had stopped injecting and had settled well on 90mg of methadone.

Around this time, her partner Owen was released and also came to register, being so impressed by the visible improvement in Elizabeth's health. He likewise settled into treatment and things progressed well. About three months later, one of the receptionists casually asked me when Elizabeth's baby was due.

I was dumbfounded - I hadn't noticed and neither had Elizabeth! On arrival she had been so unwell and underweight she hadn't had a period for many years. Then on starting treatment I had forgotten to offer contraception, which is a must.

At her next attendance the pregnancy was confirmed and Elizabeth and Owen were shocked but pleased. Charlotte was born 6 months later with mild withdrawals for about 10 days. But has not looked back since and is doing well at the local school. Charlotte was meant to be and her parents are happy that she came into their lives.

However this is not always the case. In order that women can make a choice, they need to be advised about the return of or increase in their fertility and be offered contraception at the same time as beginning treatment.

Any method of contraception is open to drug-using women and over the years women have used pills, injections, IUD and IUSs, implants and condoms. It's good practice for all women at the beginning of a relationship or change of partner, to use the method of their choice and condoms to help prevent sexually transmitted infections. After the birth of Charlotte, Elizabeth had settled on an IUD which she now wanted removed.

I smiled as I sat and remembered the slogan from my favourite birthday card from last year, which is still on my mantelpiece. It says "I've learnt so much from my mistakes, I'm thinking of making a few more"!

- Dr Chris Ford