Original Article The temporal influence of a heroin shortage on pregnant drug users and their newborn infants in Sydney, Australia Kwai Meng PONG, 1,2 Mohamed E. ABDEL-LATIF, 3,4 Kei LUI, 1,2 Alexander D. WODAK, 5 John M. FELLER, 1 Thomas CAMPBELL 1 and Julee OEI 1,2 1 Department of Newborn Care, Royal Hospital for Women, Randwick, 2 School of Women’s and Children’s Heath, University of New South Wales, Kensington, New South Wales, 3 Department of Neonatology, The Canberra Hospital, 4 Division of Women and Children’s Health, School of Clinical Medicine, Australian National University, Garran, Australian Capital Territory, and 5 Alcohol and Drug Service, St Vincent’s Hospital, Darlinghurst, New South Wales, Australia Background: Heroin availability and purity decreased precipitously in Australian markets between 2000 and 2001. This led to increased use of non-opiate drugs in the general community but whether pregnant drug users and their newborn infants were affected remains unknown. Aim: To determine if perinatal drug exposure and outcomes are affected by changes in street drug availability. Methods: Retrospective review was carried out of known drug-exposed mothers delivering live-born infants at the Royal Hospital for Women, Randwick, Australia (n = 316). Study periods were divided into preshortage (A = 1998–2000, n = 79), shortage (B = 2001–2002, n = 92) and post-shortage (C = 2003–2006, n = 122) periods. Cannabis-only users were excluded (n = 23). Results: The percentage of confined women who admitted to using heroin decreased significantly (65%(A) vs 34%(B), P < 0.01) as did women on methadone programmes (90%(A), 80%(B), 75%(C), P = 0.024). The use of cocaine (7% (A) vs 33% (B), P = 0.031) and amphetamines (4% (A) vs 22% (C), P = 0.01), tripled. Most infants were born full- term and healthy but the duration of infant hospitalisation increased significantly from (median [interquartile range]) 8 [10, 38](A) to 13 [7, 23](C) days (P < 0.01). Approximately 50% of infants required withdrawal treatment but more needed phenobarbitone as an adjunct to morphine during the shortage (4 ⁄ 80 (0.5%) vs 15 ⁄ 93 (16%), P = 0.026), probably because of increased exposure to non-opiate drugs. Conclusions: The types of drugs used by pregnant drug users follow street trends and may affect infant hospitalisation and withdrawal treatment. Of concern is the rise in amphetamine-use and there needs to be increased vigilance for similar trends, especially in previously unidentified drug users. Key words: heroin shortage, newborn, pregnancy. Introduction In Australia, more than 1% of live births are affected by known antenatal drug exposure. 1,2 Optimum care of these women and their children is challenging because of the high frequency of adverse social and medical issues generated by drug-seeking chaotic lifestyles, such as homelessness, poverty, domestic violence, criminal involvement, psychiatric comorbidities and blood-borne diseases. 2,3 The infant is at risk of possible teratogenic effects, 4 intoxication 5,6 and withdrawal 7 from maternal drugs. There is then the risk of childhood neurodevelopmental impairment because of the frequent coexistence of adverse psychosocial factors. 8–10 The types of drugs used by a mother have the potential to significantly influence perinatal outcome. For example, heroin users have the option of engaging in maintenance programmes with pharmacological substitutes such as methadone and buprenorphine but no such medical correlates are available for amphetamines or cocaine dependency. Rehabilitation programmes improve pregnancy outcome 11 and decrease drug-seeking behaviour and adverse lifestyle practices. 12 In Australia, the majority of known pregnant drug users use opiates such as methadone and heroin 1,2 and stimulant use is less common 1 but during 2000–2001, heroin availability and purity decreased markedly in all major Australian markets, particularly in Sydney and Melbourne in a phenomenon termed the ‘heroin shortage ’ . 13,14 This period was associated with a significant decrease in heroin consumption and overdoses 14 and increased methamphetamine and cocaine 15 use, violent crime and aggression. 16 The aetiology of this ‘shortage’ is most likely multifactorial, and has been attributed to improved law enforcement and border control 17,18 as well as to a correction of the heroin glut of the mid-1990s 17,18 and a Correspondence: Dr Julee Oei, Department of Newborn Care, Royal Hospital for Women, Barker Street, Locked Bag 2000, Randwick, NSW 2031, Australia. Email: ju.oei@sesiahs.health.nsw.gov.au Received 26 May 2009; accepted 31 January 2010. 230 Ó 2010 The Authors Journal compilation Ó 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2010; 50: 230–236 DOI: 10.1111/j.1479-828X.2010.01146.x Te Australian and New Zealand Journal of Obstetrics and Gynaecology