Policy and practice briefingsWomen with drug problems

Women

Issues

Women make up approximately a quarter of all people with serious drug problems and around one-fifth of all entrants to drug treatment in Europe. They are particularly likely to:

  • experience stigma and economic disadvantage, and to have less social support;
  • come from families with substance use problems and have a substance-using partner;
  • have children who may play a central role in their drug use and recovery; and
  • have experienced sexual and physical assault and abuse and have co-occurring mental disorders.

A number of sub-groups of women with drug problems have special needs. These sub- groups, which often overlap, include pregnant and parenting women; women involved in sex work, who may often experience violence and stigma; women from ethnic minorities, who may have been trafficked; and women in prison.

Response options

The types of responses needed for this group include:

  • Specific services for women. These services may be offered in female-only or mixed-gender programmes. They need to be welcoming, non-judgmental, supportive and physically and emotionally safe, in order to address stigma and trauma. They should promote healthy connections to children, family members and significant others.
  • Collaboration between drug treatment and mental health services in order to address co-occurring substance use and mental health needs.
  • Services for pregnant and parenting women, which need to deal with drug use, obstetric and gynaecological care, infectious diseases, mental health, and personal welfare, as well as providing childcare and family support.
  • Measures to overcome the barriers to care for women involved in the sex trade, such as evening opening, mobile outreach services and open access support.
  • Sensitivity towards ethnic and cultural aspects and the possibility of interpreter services when working with women from ethnic minorities.

European picture

  • The need for and the benefit of specific interventions for women who have problems with different drugs, including prescription drugs and polydrug use, should be investigated.
  • Evaluations, including cost-effectiveness studies, of interventions for women in diverse settings across Europe are needed.
  • Large knowledge gaps about women’s drug use exist for a number of reasons: studies do not always include women; those that do may not disaggregate by gender, or address gender issues; most research on drug-using women of child-bearing age only deals with opioid users; research on cannabis, new psychoactive substances, misuse of medicines and polydrug use among women is limited.

Summary of the available evidence

Evidence-based guidelines for the treatment of pregnant women who use drugs

Screening and brief interventions

Health care providers should:

  • ask all pregnant women about their use of drugs and alcohol (past and present) as early as possible in the pregnancy and at every antenatal visit; and
  • offer a brief intervention to all pregnant women using drugs or alcohol.

Psychosocial interventions

Health care providers managing pregnant or postpartum women with alcohol or other substance use disorders should offer comprehensive assessment, and individualised care.

Detoxification or quitting programmes

Health care providers should, at the earliest opportunity, advise pregnant women dependent on alcohol or drugs to cease their alcohol or drug use and offer, or refer to, detoxification services under medical supervision where necessary and applicable.

Pregnant women dependent on opioids should be encouraged to use opioid maintenance treatment rather than to attempt opioid detoxification.

Pregnant women with benzodiazepine dependence should undergo a gradual dose reduction, using long-acting benzodiazepines.

In withdrawal management for pregnant women with stimulant dependence, psychopharmacological medications may be useful to assist with symptoms of psychiatric disorders but are not routinely required.

Pharmacological treatment (maintenance and relapse prevention)

Pharmacotherapy is not recommended for routine treatment of dependence on amphetamine-type stimulants, cannabis, cocaine, or volatile agents in pregnant patients.

Pregnant patients with opioid dependence should be advised to continue or commence opioid maintenance therapy with either methadone or buprenorphine.

Adapted from WHO Guidelines for the identification and management of substance use and substance use disorders in pregnancy.

Implications for policy and practice

The implications for future development of responses for this group include:

Basics

  • Provide gender-responsive and trauma-informed services to meet the needs of particular groups of women and ensure they are accessible to all in need.
  • Provide co-ordinated and integrated services to address issues beyond drug use. This may require embedding collaboration with other services, such as mental health and children’s services, into policies and strategies.
  • Staff in specialised drug and other health and social services, who come into contact with women who use drugs, need to have appropriate attitudes, knowledge and skills to allow them to provide high quality care.

Opportunities

  • Include gender breakdowns in routine statistics in order to enhance understanding of drug use trends, sociodemographic factors and issues faced by women within a given region and develop appropriate responses.
  • Increase the participation of women who use drugs in the planning, formation and development of policies and programmes.
  • Implementation of the guidelines for provision of services for the treatment of pregnant women who use drugs has the potential to improve outcomes for both mother and child.

Gaps

  • Reduce knowledge gaps by research that addresses gender issues and considers gender in all aspects of service design in order to identify the types of intervention that are most appropriate for different groups of women.
  • Include the misuse of prescription drugs in policies and responses.

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