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， 据估计，目前孕妇使用处方药的比例约为50%。妇女所生子女， 滥用处方药者更容易患有新生儿禁欲综合征， 在过去五年里翻了一番。最近的国家调查数据表明，目前非法药物使用率 在怀孕少女中为14.6%，在年轻人中为8.6%，在成年人中为3.2%。的第一步 识别处方药滥用和怀孕期间非法药物使用是筛查;然而，没有具体的 物质使用筛选器已被推荐用于孕妇，以确定非法或处方 吸毒拟议的研究将比较和验证三个现有的物质使用筛选- 4 P的加， NIDA快速筛查/ASSIST和物质使用风险概况-妊娠量表-至少500人 在巴尔的摩两个初级保健诊所就诊的孕妇按妊娠三个月分层， 年具体目标是：（1）进行有效性分析，以确定敏感性，特异性，可用性，以及如何 每一个尺度都与其他尺度以及尿液和毛发药物检测的金标准进行比较， 处方药和非法药物的使用;（2）确定临床人群变量（年龄，种族， 怀孕）对三种物质使用筛查的有效性;和（3）评估出生结果（出生体重， 胎龄、头围和新生儿重症监护病房（NICU）入院情况）与最广泛使用的处方相关 药物和多种药物暴露。这项研究的最终目标是确定哪种筛查工具最有效。 有效地查明孕妇中处方药滥用和非法药物使用情况， 基于指导可以提供给临床医生，利用生化药物测试作为金标准， 指定使用和电子病历（EMR）作为识别处方药的补充。目标3是 增加了药物使用和出生结果之间重要和相关的关联。

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.