Contraceptive Recommendations for Women with Cocaine Use and Vaping
For women with a history of cocaine use and current vaping habits, long-acting reversible contraceptives (LARCs) such as intrauterine devices (IUDs) are strongly recommended as the first-line contraceptive option due to their high efficacy and safety profile in this population.
Rationale for LARC Recommendation
Cocaine use is associated with 1.55 times greater risk of future cardiovascular hospitalization during follow-up, with particularly strong associations with inflammatory heart disease, cardiac arrest, valve disease, and arterial embolism 1
Vaping, like smoking, introduces cardiovascular risks that may contraindicate estrogen-containing contraceptives
Combined hormonal contraceptives (CHCs) increase the risk of venous thrombosis from 2-3 per 10,000 women-years to 7-10 per 10,000 women-years 2
Women with multiple cardiovascular risk factors should consider progestogen-only contraceptives instead of combined hormonal methods 3
Recommended Contraceptive Options (In Order of Preference)
1. Levonorgestrel IUD (First Choice)
- Highest efficacy with failure rate of 0.1-0.2% 4
- No estrogen-related cardiovascular risks
- Provides 3-8 years of protection depending on type
- No daily compliance required
- Can be safely used in women with conditions where estrogen is contraindicated 4
2. Copper IUD (Excellent Alternative)
- Non-hormonal option with failure rate of 0.8% 4
- Avoids all hormone-related risks
- Provides up to 10 years of protection
- No interaction with substances or medications
3. Contraceptive Implant
- Highly effective with failure rate of 0.05% 4
- Progestin-only, avoiding estrogen-related cardiovascular risks
- Provides 3-5 years of protection
- No daily compliance required
4. Depot Medroxyprogesterone Acetate (DMPA)
- Progestin-only injectable with typical failure rate of 0.3-6% 4
- Administered every 13 weeks (150 mg IM or 104 mg subcutaneous)
- May cause irregular bleeding initially but often leads to amenorrhea with continued use 4
- Requires monitoring for weight gain, especially in first 6 months 5
Contraceptives to Avoid
Combined Hormonal Contraceptives (Pills, Patch, Ring)
- NOT recommended for women who use cocaine and vape due to:
- Increased risk of cardiovascular events with combined use of substances and estrogen
- Current smokers using CHCs have 10-fold increased risk of myocardial infarction 3
- Cocaine use significantly increases long-term cardiovascular risk 1
- According to US Medical Eligibility Criteria, substance use that increases cardiovascular risk makes CHCs a Category 3-4 (risks usually outweigh benefits or unacceptable health risk) 5
Less Effective Methods
- Progestin-only pills (5-9% failure rate) 4
- Barrier methods like condoms (14-21% failure rate) 4
- These methods require consistent use and have higher typical failure rates
Follow-up Considerations
- Regular cardiovascular risk assessment
- Substance use counseling and support for cessation
- For women who choose DMPA, monitor for weight changes and consider bone health with calcium and vitamin D supplementation 5
- For IUD users experiencing heavy bleeding, NSAIDs can reduce menstrual blood loss by 26-60% 4
Important Cautions
- Inconsistent or incorrect use of contraceptives is a major cause of contraceptive failure 5
- Women who frequently miss pills or experience other usage errors should strongly consider a LARC method 5
- The risk of unintended pregnancy in this population carries significant health implications given the cardiovascular risks associated with both cocaine use and pregnancy
By prioritizing LARCs for women with cocaine use and vaping habits, healthcare providers can help ensure effective contraception while minimizing cardiovascular risks associated with estrogen-containing methods.