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.