A reply to the Liverpool Drug Clinic Pregnancy Support Group

422

Letters to the Editor

women throughout their contact with us. Additionally, great efforts were made to recontact SIR—We are delighted to learn of the recent women and encourage them to re-attend when establishment of the Liverpool Drug Clinic Preg- they lost contact with the service (see p. 868). nancy Support Group' and look forward to Given the similarity in service input, it is interreading any reports published from this group. esting that so few children in the Liverpool The service appears to have been extremely suc- sample were placed on child protection registers. cessful in both attracting women to treatment From a clinical perspective we did not disagree and retention. However, the interpretation of our with any of the decisions made by social services results and an understanding of the nature of our in our sample. This raises the possibility that the two samples differ in certain important respects: own service require some further clarification. With reference to the rate of neonatal with- perhaps life style factors, stability, social support? drawal, we agree that in the absence of a Unfortunately, we did not include such measures systematic rating scale, subjective clinical deci- in our study. However, further studies which sions about the need for medication may be attempt to take account of such factors would influenced by attitudes and beliefs about drug enable comparison to be made between different users. However, two further points need to be samples and studies. These factors may also considered. We found a significant relationship influence retention and treatment compliance/ between maternal methadone dose at delivery success (however that may be defined). and the subsequent development of neonatal Rather than viewing our results as discouragwithdrawal. High maternal dose was associated ing, "* we feel that the service was extremely with neonatal withdrawal. While obstetric staff successful in attracting women to treatment, was would be aware of the mother's drug use we innovative in providing antenatal and primary would not expect that babies bom to high dose health care in a non medical setting, and made a users would be at greater risk of incorrect pre- significant contribution to the literature by scribing than babies bom to low dose users. providing data on matemal dose and neonatal While we cannot rule out the possibility that withdrawal. some babies were unnecessarily medicated, the significant finding does argue against Morrison et a/.'s' suggestion that our rate of neonatal withdrawal was based upon false identification of SHARON DAWE, CLAIRE GERADA & JOHN STRANG neonatal withdrawal. National Addiction Centre, Second, in the American studies referenced^'' Institute of Psychiatry, there was no indication in the text of the reports DeCrespigny Park, that the authors were adopting a moralistic or London judgemental attitude. Therefore, attributing the SE5 8AF higher rates of neonatal withdrawal to this must remain conjecture. It is notable that the American studies often report that women were using considerably more opiates during their preg- References nancy and at delivery than in our sample. This is 1. MORRISON, C . L . , RUBIN, S. M . , SINEY, C , WORTHiNGTON, M., YOUNG, L . & MURPHY, S. (1992) consistent with our own findings pertaining to Liaison Services for Pregnant Drug Users (letter), neonatal withdrawal and maternal dose at Addiction, 88, pp. 411-412. delivery. We are most interested to learn of the 2. KALTENBACH, K. & FiNNEGAN, L. P. (1986) Neonatal abstinence syndrome, pharmacotherapy and maternal opiate dose in the Liverpool sample developmental outcome, Neurobehavioural Toxicolas this will provide further data from which to ogy and Teratology, 8, pp. 353-355. determine the influence of maternal dose (and 3. CHASNOFF, I. J., BURNS, W . J. & SCNOLL, S. H . probably route of administration) on neonatal (1986) Prenatal drug exposure; effects on neonatal withdrawal. infant growth and development, Neurobehavioural Toxicology and Teratology, 8, pp. 357-362. Like the Liverpool Service we liaised exten4. DAWE, S., GERADA, C . & STRANG, J. (1992) Estabsively with all relevant obstetric and social work lishment of a liaison service for pregnant departments, and individual key workers proopiate-dependent women, British Journal of Addicvided support and one to one therapy for the tion, 87, pp. 867-871. A reply to the Liverpool Drug Clinic Pregnancy Support Group