Comparison of Substance Use Screeners in Assessing Prescription Drug Abuse and Other Illicit Drug Use among Pregnant Women

项目摘要 在过去的30年里，处方药的使用增加了60%以上， 目前估计，孕妇使用处方药的比例约为50%。妇女所生的孩子 滥用处方药更有可能出生时患有新生儿禁欲综合征， 在过去的5年里翻了一番。最近的全国调查数据显示，目前非法药物使用率 在怀孕的青少年中为14.6%，在年轻人中为8.6%，在成年人中为3.2%。的第一步 在怀孕期间同时识别处方药滥用和非法药物使用是一种筛查；然而，没有具体的 已建议孕妇使用物质使用筛查器来识别非法或处方 吸毒。这项拟议的研究将比较和验证现有的三种物质使用筛查方法-4P‘s Plus， NIDA快速筛查/辅助，以及物质使用风险概况--妊娠量表--至少500人 在巴尔的摩两家初级保健诊所就诊的孕妇按怀孕三个月分层，年龄超过1 年。具体目标是：(1)进行有效性分析，以确定敏感度、特异度、可用性以及如何 每一种量表都与其他量表进行比较，并与尿液和头发药物测试的黄金标准进行比较，以确定 处方和非法药物使用；(2)确定临床人口变量(年龄、种族、怀孕三个月)的影响 三种物质使用筛查者的有效性；以及(3)评估出生结果(出生体重， 胎龄、头围和NICU入院)与最广泛使用的处方相关 毒品和多药暴露。这项研究的最终目标是确定哪种筛查工具(S)最 有效识别孕妇中的处方药滥用和非法药物使用，以便证据- 可以向临床医生提供以生化药物测试为金标准的指导 指定使用和电子病历(EMR)作为识别处方药的补充。目标3是 添加以捕捉药物使用和出生结果之间的重要和相关关联。

Project Summary Over the last 3 decades, use of prescription drugs has increased by more than 60%, and prevalence of prescription drug use among pregnant women is currently estimated around 50%. Children born to women who abuse prescription medications are more likely to be born with neonatal abstinence syndrome, the incidence of which has doubled in the past 5 years. Recent national survey data show that the rate of current illicit drug use is 14.6% among pregnant adolescents, 8.6% among young adults, and 3.2% among adults. The first step in identifying both prescription drug abuse and illicit drug use during pregnancy is screening; however, no specific substance use screener has been recommended for use with pregnant women to identify illicit or prescription drug use. The proposed study will compare and validate three existing substance use screeners - 4 P’s Plus, NIDA Quick Screen/ASSIST, and the Substance Use Risk Profile-Pregnancy scale - among at least 500 pregnant women stratified by trimester of pregnancy presenting to two primary care clinics in Baltimore over 1 year. Specific aims are to: (1) conduct validity analyses to determine sensitivity, specificity, usability, and how each scale compares to the others and to the gold standard of urine and hair drug testing in identifying prescription and illicit drug use; (2) determine the impact of clinic population variables (age, race, trimester of pregnancy) on validity of the three substance use screeners; and (3) assess birth outcomes (birth weight, gestational age, head circumference, and NICU admissions) associated with the most widely used prescription drug and multi-drug exposure. The end goal of the study is to determine which screening tool(s) is most effective in identifying prescription drug abuse and illicit drug use among pregnant women so that evidence- based guidance may be offered to clinicians, utilizing biochemical drug testing as the gold standard to designate use and electronic medical records (EMR) as a supplement to identify prescribed drugs. Aim 3 was added to capture the important and relevant associations between the drug use and birth outcomes.