"Concurrent increases in methamphetamine, injection drug, and heroin use have been described in women with syphilis... The prevalence of substance use (e.g., tobacco, alcohol, cannabis, illicit use of opioids, and other illicit, nonprescription substances) in persons with a congenital syphilis pregnancy outcome (48.1%) was nearly double that among those with a noncongenital syphilis pregnancy outcome (24.6%). Persons with a congenital syphilis pregnancy outcome were six times as likely to report illicit use of opioids and four times as likely to report using other illicit, nonprescription substances during pregnancy than were persons with a noncongenital syphilis pregnancy outcome."
Carlson, J.M., et al. (2023). Substance Use Among Persons with Syphilis During Pregnancy - Arizona and Georgia, 2018-2021. Morbidity and Mortality Weekly Report 72(3): 63-67. https://www.cdc.gov/mmwr/volumes/72/wr/mm7203a3.htm?s_cid=mm7203a3_w