PREVALENCE OF ILLICIT DRUGS DETECTED IN THE URINE OF WOMEN OF CHILDBEARING AGE IN ALABAMA PUBLIC-HEALTH CLINICS

Each year, it is estimated that from 350,000 to 739,000 U.S. infants a re exposed in utero to one or more illicit drugs. To estimate the prev alence of and risk factors for illicit drug use by women of child-bear ing age in Alabama, during 2 months in 1991 the authors collected pati ent-reported histories, clinical histories, and urine specimens from 6 ,195 women statewide attending public health maternity clinics, family planning clinics, and a high-risk referral obstetrical clinic. Blind drug screening of urine specimens for marijuana, cocaine, opiates, bar biturates, and amphetamines was performed with the use of a fluorescen t polarization immunoassay. The overall prevalence of positive results for drugs tested was 10.1 percent, including 8.4 percent of the 3,554 pregnant and 12.3 percent of the 2,571 non-pregnant women screened. T he drugs most frequently detected were marijuana and cocaine. Characte ristics of the subjects associated with a higher prevalence of positiv e results for any drug tested or for marijuana included white race, ol der age, being divorced, nonstudent occupation, having 12 or less year s of education, attending a clinic located in a suburban county, self- reported substance use, increased risk for human immunodeficiency viru s infection, and reproductive history. Characteristics of women with p ositive screening for cocaine results were similar to those who tested positive for any drug, except that the prevalence of cocaine was high er among black women and those attending urban county clinics and did not vary by years of education. Patient-reported histories of drug use were insensitive in identifying women who had positive drug screening results (sensitivity, 6.3 percent; specificity, 98.2 percent). Thus, in this study, the use of illicit drugs among women of childbearing ag e attending public clinics in Alabama was common and emphasizes the ne ed for targeted drug education and interventions to reduce the impact of drug use on this high-risk population.