Cannabis and other illicit substances
Six studies discussed cannabis alongside other illicit substances65-70. These papers did not have defined groups of substances, but rather studied perspectives or experiences with substance use in pregnancy more generally, offering long lists of the substances that participants discussed. Five of these studies were conducted in the United States 65, 66, 68-70, and one in Canada 67. In this collection of studies, medical cannabis use was legal in all but one jurisdiction65and recreational use was illegal in all but one jurisdiction.70 Of these six articles, five sampled participants from perinatal substance abuse treatment programs 65, 67-70. One recruited from public agencies and community organizations66. This collection of studies started from the assumption that abstaining from substance use was necessary and desirable, and examined the barriers and facilitators of quitting. Accordingly, the main decision posed to participants in these studies was not whether to quit but how .
Perceptions of the risks of substance use in pregnancy were frequently discussed. Participants discussed drug-related arrests and criminal involvement, including fear that child protective services would take away their child 66-70. Participants also discussed perceptions of the harm to the fetus, and to their ability to parent other children, and their feelings of worry or guilt about this66-70. Some participants denied feeling worried about harming their baby, citing other children they knew to be prenatally exposed to similar substances without notable harm 70. Healthcare providers were often viewed as a source of punishment, rather than protection or resources 68, 69.
There was very little discussion of why participants chose to use substances, or what benefits they may have experienced. This topic is only present in the quotes from individual participants and not addressed by the authors. Relationships with other people who use substances was cited as a factor which normalized and made substances difficult to quit, although this was framed as a barrier to quitting rather than a benefit of use 67, 69, 70.
Because the main decision considered was how to quit, notwhether to quit, the influential factors in this decision focused on available support and resources to quit, and perceptions of self-efficacy about quitting 65-70. Similarly, content about information use focused on the identification of resources to support cessation and parenting 67, 69, 70. Typically, these sources were related to the substance-abuse program the participants were enrolled in at the time of recruitment.