Asking about Past Drug Use Among Pregnant Patients

Background: Illicit drug use during pregnancy is associated with negative pregnancy, infant and maternal outcomes. Past illicit drug use is a predictor of perinatal drug use. However, little is know whether obstetric care providers screen for past drug use during clinic visits. Objective: To examine patient-provider discussions during the first obstetric visit for screening of past drug use. Methods: First obstetric visits between obstetric care providers and pregnant patients were audio-recorded. Conversations were qualitatively analyzed for drug screening questions; these questions were then categorized by whether the provider specifically asked about past or present use. Results: Two-hundred fifty patients and 56 obstetric care providers participated. In 224 visits (89.6%) providers screened for illicit drug use in some manner. Providers asked specifically about current use in 78 visits (31.2%), and about past use in 60 visits (24.0%). In 143 (57.2%) visits, questioning about drug use did not specify past or current use (e.g., "Drugs?" or "Any drug use?"). Seventy-three patients (29.2%) disclosed illicit drug use. Patient disclosure of drug use was associated with questions specifying past (RR 3.30; 95% CI 2.34-4.63) or current (RR 1.99; 95% CI 1.40-2.85) use. Disclosure was less likely if the screening did not specify time of use (RR 0.34; 95% CI 0.23-0.51). Conclusion: A provider specifically asking about past and current drug use are both effective but underutilized techniques for identifying illicit drug use among pregnant patients. Providers who screen using general, nonspecific questions may be missing opportunities for intervention during the first obstetric visit.