Reproductive System & Sexual Disorders: Current Research
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Clinical Recommendations from the Society of Modern Contraceptives on Contraception and Abortion Therapy for Substance Users

Suktana Zara^{* *}Correspondence: Suktana Zara, Department of Obstetrics and Gynecology, Omdorman Islamic University, Khartoum, Sudan, Email:

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About the Study

Substance abuse and disorders associated with it continue to be serious public health concerns. Addiction is a condition that has a stigma and is poorly understood. Since people who use substances or are diagnosed with a substance use disorder frequently encounter internalized stigma and overt discrimination within the healthcare system, accessing contraceptive and abortion care is particularly difficult. There are few recommendations and no evidence to back them up for the clinical care of people with substance use disorders who seek care for abortion or contraception. This professional advice from the Society of Family Planning concerns counseling, providing contraception and abortion to those who use drugs or have a substance use disorder. The recommendations employ extrapolations of as there are essentially no safety or effectiveness data on contraception, abortion, substance use, and medical issues that are related to substance use disorders as necessary.

The use of illegal substances and the resulting morbidity continue to pose a major threat to human health. Opioid Use Disorder (OUD) continues to be the dominant reason of overdose deaths in the United States, where 7.2 million women have been acknowledged an SUD. Cannabis and amphetamine usage have been rising along with opiate use. Since most drug users do not become addicted to their use, and since a substance's negative effects are not limited to addiction, using a substance does not indicate that a patient has a substance use problem. When compared to those without substance use disorders, reproductive-aged people with substance use disorders may suffer altered reproductive health outcomes, such as greater prevalence of STIs and unexpected or unplanned pregnancies. The median rate of contraceptive use is consistently lower than that of the overall population.

With the exception of nicotine and alcohol, this guideline attempts to offer recommendations for safe abortion and contraceptive care for people who use drugs or have a substance use problem, with a focus on people who use opioids. The recommendations may not distinguish between those who use substances and those who have a diagnosis of a substance use disorder because extant data does not support clear differences in guideline recommendations because there is currently few safety or efficacy data on the impact of substance use on contraception or abortion. Instead, the recommendations extrapolate from conditions that are closely related to substance use disorders when necessary. In order to reflect both individuals with a formal diagnosis of a substance use problem.

Two groups of medications are used in the evidence-based management of the chronic condition known as opioid use disorder: naltrexone and the agonists’ methadone and buprenorphine (antagonists). Only opioid treatment programmes with government certification may provide methadone, an opioid receptor agonist.

A partial opioid receptor agonist, buprenorphine can be obtained from an opioid treatment programme or administered by doctors with a "X" DEA waiver. These agonist Medications for Opioid use Disorder (MOUD) address the withdrawal symptoms without producing exhilaration when properly delivered. Opioid use disorder antagonist medications don't help people with injuries or surgical procedures manage their pain. A licenced clinician may prescribe naltrexone, an opioid receptor antagonist. When properly delivered, naltrexone prevents the opioid agonist effects (Appendix A describes principles medication for opioid use disorder).

The evidence base for treating drug use disorders caused by substances other than alcohol or nicotine is more constrained.

The Food and Drug Administration has not approved any drugs to treat amphetamine, cannabis, or sedative use disorders.

Both alcohol and benzodiazepines should not be abruptly stopped because it can be lethal. People who utilize substances frequently use many substances. Notably, many illicit drugs are contaminated with additional drugs that the user might not be aware of, resulting in side effects, hazardous effects, and toxicology test results that don't match the user's perception of their drug usage. The patient-provider relationship can be safeguarded by providers' understanding of this phenomenon, particularly in cases where reporting and toxicological results are inconsistent. People with addiction commonly endure internalized stigma based on earlier healthcare experiences, as well as outward stigma from physicians and the healthcare system. For instance, individuals with drug use disorders may be more likely to receive subpar pain management due to their disease-related hyperalgesia as well as inaccurate and prejudiced provider assumptions. Common provider misconceptions include thinking that people with substance use disorders are "med-seeking" and that medications for addiction therapy give analgesia.

Additionally, the prohibition of drug use has encouraged potentially coercive reproductive techniques, such as the use of sterilization or long-acting reversible contraception that is rewarded financially or with lenient criminal justice consequences. When advising people on family planning alternatives, reproductive health physicians must keep this sociohistorical background in mind.

Most substance-using patients can have a surgical abortion without risk in an outpatient environment. The use of ambulatory and outpatient surgical facilities for surgical abortions under moderate or heavy anaesthesia is supported by a wealth of data. Patients who use substances can benefit from the standard recommended protocols necessary for the administration of routine moderate sedation, which vary by state and institution but typically include vital sign monitoring, easily accessible reversal agents, possibly capnography, and access to emergency care.

Toxicology testing should only be used in certain circumstances, such as monitoring patients who have been administered MOUDs or banned narcotics, according to the American Society of Addiction Medicine (ASAM). Urine toxicology testing should be used as an addition to confirm use, not as a screening tool, according to the American College of Obstetricians and Gynecologists (ACOG). Best practices for doctors using toxicological testing include gaining patient consent and creating a clear plan for handling possible outcomes. The results of the tests should always be disclosed to the subjects. Testing for toxicology should never be used as a screening method. Clinicians should respect the autonomy of anyone who refuses to engage in testing when using toxicological tests.

Conclusion

For people who utilize drugs, doctors may examine other methods of anesthetic. When administered by a qualified anaesthesia physician, protocol anaesthesia is a safe choice for patients who use drugs, particularly opioids, because it fully bypasses the opioid receptors. Ketamine, which is more frequently used in outpatient clinics due to a lower risk of respiratory depression, may also benefit this population from anaesthesia because it is a well-established adjuvant anaesthetic agent that does not need to be administered by an anesthesiologist. Ketamine doesn't need any special monitoring. Midazolam may help to some extent in reducing the dysphoria or hallucinations that ketamine might induce.