As suggested in the paper by Farkas et al. (Vol 102, July 1995)1 drug misuse is becoming more prevalent in the United Kingdom. The largest system of regular monitoring for the extent of drug misuse is by the Regional Drug Misuse Database Teams, which collect data sent by health care services, from forms which are completed whenever a new episode of problem drug misuse occurs; 4363 women presented with an episode of drug misuse in the six months between October 1 1993 and March 31 1994, with opiates and methadone being used by 96% of drug misusers2. In a recent national survey3 of obstetric units the annual rate of pregnancy in drug misusers has been estimated at 11%. The data of Farkas et at. confirm that there is a significant number of women presenting with drug misuse in pregnancy.
We are concerned that it may be presumed in some maternity units that anonymous urine testing is the best way to identify such women. It is unethical for an obstetrician or a midwife to perform an investigation without informed consent. Pregnant women should be aware of what tests are being carried out and the implications of the results of these tests. As discussed by Farkas et al. legitimate prescribed medications may produce similar results as illicit drug misuse and so correct interpretation of the results may be difficult. Drug treatment agencies through the country are trying to standardise the care of pregnant drug users; however, some agencies still pursue discriminatory practices and social services may consider all drug users as unfit parents. These factors would influence the decision to consent to testing. Another problem is that urinalysis only detects the presence of drugs and not the extent of misuse. Obstetric services should not work in isolation and require the support and cooperation of drug treatment agencies. Urinalysis is used by such agencies as a guide to compliance and progress with the drug rehabilitation treatment plan and is never used to penalise women; as is the case in some agencies in the USA4.
The way forward is for local services to ensure that they provide services that address the needs of this group of women and in so doing attract women voluntarily into rehabilitation services5. Treatment of drug misuse in pregnancy can be costly and outcomes difficult to define. We suggest that there should be a national surveillance system that monitors drug misuse in pregnancy similar to the AVERT scheme which monitors HIV in pregnancy6. Such a surveillance programme would disseminate examples of good practice, could monitor the types of drugs used ad routes of administration, and whether any formal treatment programme was available to women. The programme could also monitor for neonatal abstinence syndromes, congenital malformations and the effectiveness of statutory child.