Prevalence and implications of multi-drug abuse in a population of methadone-maintained women

Within our study population of 100 women for whom 3,980 urine toxicology reports were accomplished, 98 percent were multi-drug users. This proportion is far greater than would have been calculated from the percent of urines that were positive for the drugs of abuse and is a more realistic estimate of the extent of the problem than is often reported. Despite this high percentage of multi-drug use, due to the uniqueness of our patient population (pregnant women), it is not possible to deny them pharmacologic therapy for their addiction. Therefore, the use of urine toxicology reports in our clinical setting has broader implications than adherence to the methadone regulations. These reports serve as excellent devices to assess newborn abstinence symptomatology, in addition to helping us monitor the physical and psychological status of our patients. The implications are that self-medication may be used to achieve a particular effect concomitant with methadone therapy. The effects are generally to enhance the action of methadone and to decrease undesirable side effects.