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Re: drug screen in pregFrom: ainsron (ainsron@sbcglobal.net)Tue May 30 10:22:11 2006
You have to ask yourself why do they want random drug screening - is it to help with patient care, to improve outcome of children, to decrease liability, to punish users..? If it is to improve patient care and outcome of children, there are no studies that show a benefit in random drug screening to our patients. If want you look into the subject a little further, a great source of information and education on the topic of drug screening in pregnancy is the Children's Research Triangle, its principle researcher is Ira Chasnoff. He has developed a screening tool that is used on all OB patients in my practice and most in my county that is highly predictive of substance abusers. The real issue is not simply identifying users, it is to offer them gender specific treatment programs to assist them in getting off drugs, staying off drugs and improving the outcomes of their pregnancy and their fetus as well as early identification and treatment of drug exposed children. That is the real genius of Ira's program, the integration of services within a community to focus the resources where they can improve outcomes. I was involved in a team that went through his training program four years ago. It also included a pediatrician, a midwife and leaders of several of our county's departments - behavioral health, public health, the district attorney, the chief judge of the drug court. We came back from the training and developed a committee of community members who have continued to provide ongoing education for providers and treatment programs for our patients. http://www.childstudy.org/crt/ His article in NEJM,322:1202-1206, 26 Apr 90, The prevalence of illicit-drug or alcohol use during pregnancy and discrepancies in mandatory reporting in Pinellas County, Florida, is a classic. His screening tool is outlined in AM J Obstet Gynecol 2002; 184:752-8, Screening for substance use in pregnancy: A practical approach for the primary care physician. His article in the Journal of Substance Abuse Treatment, V17, #1-2, pp 139-148, 1999 outlines the factors which facilitate and prevent successful treatment programs. Don't get me wrong, urine and meconium drug screening does have a place in my practice, but primarily in patients who present with preterm labor or at risk behavior without prenatal care, etc. Sorry, this is a long answer to a short question. Ronald E. Ainsworth, MD, FACOG -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Babycatchers@aol.com Sent: Sunday, May 28, 2006 6:57 PM To: Multiple recipients of list OB-GYN-L Subject: drug screen in preg Do any of you do routine random drug screens in pregnancy? Our referral center wants us to have one done on all the transfers, but they still haven't sent us a protocol for it yet. I put in our new OB booklet that the mom may be tested at any time during pregnancy for drug use, so it is not a shock to the patients. The OBs and I are talking about doing one RDS at one of the lab draw visits. I don't want to reinvent the wheel if someone already has a good protocol. Vicki Smith, CNM, MSN Midwives- changing the world one baby at a time.
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