Clinical & Policy Updates: SMMGP Clinical Update #40 - May 2014

Papers & Reports

Substance, structure and stigma: parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periods
Chandler A, Whittaker A, Cunningham-Burley S, et al. Int J Drug Policy 2013;24:e35-42

This paper reports on a Scottish qualitative study that interviewed 19 opioid-dependent service users (14 women and 5 men) who were all expecting, or had recently had, a baby. The aim was to explore the impact of opiate substitution therapy (OST) on parents and their experience of parenting support.

The authors described how the participants were orientated toward demonstrating that they were doing "the best thing" for their baby. Opiate substitution therapy was seen by some as a route into normal family life - but it was also perceived by others as being a barrier. Important themes included: the physiological effects of OST; the structural challenges of treatment regimes and medication collection; and the impact of society's negative views.

Commentary: This can be an area of practice mired in tragedy and sadness. This paper tries to cut through some of the raw emotion, the blind prejudice, and ambiguity that often clouds discussions around parenting for people on OST. It's all horribly complex and trying to pick out a single key point from a paper like this is nearly impossible. Attitudes to OST vary hugely and that is, perhaps, the main message from this study - it clearly points out how treatment-by-numbers is a crackpot fantasy of policy makers. All we can do is consult on an individual basis and take account of the person's own beliefs and desires. One quote highlights the anxieties people have about negative associations with OST - but also the unclouded clarity of thinking children can display:

"I've ta'en her [older child] to the chemist with me a couple o' times... and I dinnae like daein it cos I'm still on supervised. But she's just, "Ah, mum, get your medicine, are you all better now?" But it's no' something I like daein in front of her..."

I often think a decent qualitative paper like this is worth a dozen meta-analyses when it comes to managing day-to-day consultations. It would be hard to read this paper and not call it to mind the next time you see a pregnant woman or a new mum and their partner.

Other reports and papers can be seen here