Drug misusers are increasingly seen as patients requiring care, rather than as confirmed delinquents. But is this the case with pregnant women who misuse drugs? What kinds of care are available to them? Can special provision be made for them? What ethical issues arise? The aim of this seminar held in Strasbourg in May 2000 was to review the situation in the field of care provision for drug-misusing pregnant women and suggest new areas of work for the future.
These guidelines have been developed to enable professionals to assist women who are pregnant, or have recently had a child, and who use alcohol or drugs or who have a substance use disorder, to achieve healthy outcomes for themselves and their fetus or infant. They have been developed in response to requests from organizations, institutions and individuals for technical guidance on the identification and management of alcohol, and other substance use and substance use disorders in pregnant women. They were developed in tandem with the WHO recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy.
Abstract: This book addresses the use of drug groups for various clinical indications during pregnancy. In general, non-pharmacologic remedies are recommended if these will suffice before drug therapy is instituted. Known adverse effects of drugs are documented and caution is advised because of the many unknowns about long-term effects of drug exposure to the developing fetus. Drugs used for the common cold, antituberculosis agents, antihypertensives, anticonvulsants, and marijuana and cocaine are included.
This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.
Why is it that certain people use drugs in the first place and then why do some become dependent following repeated use while others do not? What are the possible implications of the current state of affairs of research from a biomedical or more aptly put, a Neuroscience perspective, including an ethical point of view? These are questions the author attempts to answer as the biomedical or neuroscience research in the drug field is a fast moving area with ethical implications that have arisen as a result of the conduct of such research.
Neonatal Formulary provides comprehensive guidance on the safe use of the drugs prescribed during pregnancy and commonly given to babies during labour and delivery, as well as during lactation and the first year of life. Treating the journey from pregnancy to parenthood as a continuous event, the new edition contains updated information on how the drugs affect both mother and baby. The first part of the book focuses on drug storage, drug licensing, and drug prescribing. In addition, it explains to why the metabolism of drugs differs in premature and sick infants, and why the practice of extrapolating doses from adult studies is unsafe. Patient safety, excipients, and therapies that affect drugs are also covered. Part 2 consists of monographs for over 250 drugs that may find use in the neonatal unit, and possibly outside it. Each monograph is divided into sections covering use, pharmacology, treatment, drug interactions or other administration, information, supply and administration, and references. The monographs are evidence-based and include links to the Cochrane Database of Systematic Reviews, and national guidelines. The third part presents information on additional drugs, and groups of drugs, that are often taken by mothers during pregnancy, labour, or during breast feeding. The drugs discussed in this section all affect the foetus or infant. Containing far more detail than is available in the British National Formulary for Children, and with additional online material featuring updates related to specific drugs and dosing, Neonatal Formulary is an essential guide for neonatologists, neonatal nurses, hospital pharmacists, obstetric staff, advanced nurse practitioners and for all health care professionals caring for pregnant women and their infants in the first year of life.
This publication, part of the Ethical Eye series, contains contributions from a multidisciplinary group of authors from a range of different countries in Europe which examine ethical questions arising from public policy aspects of drug addiction and the use of illicit drugs. Topics discussed include: drug prevention and education; drug testing in the workplace; the financial costs of treatment in light of other medical or socio-economic needs; information processing and data confidentiality; and compulsory treatment issues.
A tiny African-American baby lies in a hospital incubator, tubes protruding from his nostrils, head, and limbs. "He couldn't take the hit," the caption warns. "If you're pregnant, don't take drugs." Ten years earlier, this billboard would have been largely unintelligible to many of us. But when it appeared in 1991, it immediately conjured up several powerful images: the helpless infant himself; his unseen environment, a newborn intensive care unit filled with babies crying inconsolably; and the mother who did this -- crack-addicted and unrepentant. Misconceiving Mothersis a case study of how public policy about reproduction and crime is made. Laura E. Goacute;mez uses secondary research and first-hand interviews with legislators and prosecutors to examine attitudes toward the criminalization and/or medicalization of drug use during pregnancy by the legislature and criminal justice system in California. She traces how an initial tendency toward criminalization gave way to a trend toward seeing the problem of "crack babies" as an issue of social welfare and public health. It is no surprise that in an atmosphere of mother-blaming, particularly targeted at poor women and women of color, "crack babies" so easily captured the American popular imagination in the late 1980s. What is surprising is the way prenatal drug exposure came to be institutionalized in the state apparatus. Goacute;mez attributes this circumstance to four interrelated causes: the gendered nature of the social problem; the recasting of the problem as fundamentally "medical" rather than "criminal"; the dynamic nature of the process of institutionalization; and the specific features of the legal institutions -- that is, the legislature and prosecutors' offices -- that became prominent in the case. At one levelMisconceiving Motherstells the story of a particular problem at a particular time and place how the California legislature and district attorneys grappled with pregnant women's drug use in the late 1980s and early 1990s. At another level, the book tells a more general story about the political nature of contemporary social problems. The story it tells is political not just because it deals with the character of political institutions but because the process itself and the nature of the claims-making concern the power to control the allocation of state resources. A number of studies have looked at how the initial criminalization of social problems takes place.Misconceiving Motherslooks at the process by which a criminalized social problem is institutionalized through the attitudes and policies of elite decision-makers. Author note: Laura E. Gomezis Acting Professor of Law and Sociology, University of California, Los Angeles.
This thoroughly revised edition of Prescribing in Pregnancy is a practical and authoritative guide for all doctors who prescribe for pregnant women. Covering both the prescribing of drugs for common conditions in pregnant women and the effect of different drugs on pregnancy, the fourth edition now also features: strengthened evidence for the prescribing regimens updated prescribing information throughout a new user-friendly design Written by leading specialists, Prescribing in Pregnancy covers the common medical problems encountered in pregnancy, and includes information on travel medicine, breast feeding and the management of drug and alcohol abuse. The fourth edition of this comprehensive and relevant book is an invaluable reference for the busy doctor, on the wards and in general practice.
