Anesthetic management of the drug-abusing parturient: are you ready?

[...]given the high frequency of concomitant opioid abuse in cocaine-abusing parturients, anyone suspected of cocaine abuse should be tested for other illicit substances,12 and opioid antagonists or agonist-antagonists administered via any route should be used with extreme caution to guard against the possibility of precipitating acute withdrawal.13 Anesthesia personnel should be aware that untoward reactions during anesthesia may be the result of drug abuse, and it is my hope that Kuczkowski's review article will help in this regard. Because illicit substance use has become so prevalent in our society, if an untoward reaction occurs during an otherwise uneventful anesthetic, the anesthesiologist should consider the possibility of drug abuse and therefore order a toxicology screen. While nonconfrontational patient history taking and toxicology screening are helpful, many patients who abuse drugs will deny drug use to their physicians; moreover, not all party drugs will yield positive toxicology results. [...]the possibility of illicit substance abuse should always be considered and testing performed whenever appropriate.