Infants Born to Opioid-Dependent Women in Ontario, 2002–2014

Brogly, Susan B.; Turner, Suzanne; Lajkosz, Katherine; Davies, Greg; Newman, Adam; Johnson, Ana; Dow, Kimberly

doi:10.1016/j.jogc.2016.11.009

Cited by 50 publications

(45 citation statements)

References 27 publications

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“…Our results expand on a well-established pattern in the literature showing increases in rates of neonatal abstinence syndrome over time [30][31][32] by demonstrating that, in Ontario, the syndrome is disproportionately experienced by infants from low-income neighbourhoods. This finding is consistent with findings from other jurisdictions outside of Canada.…”

Section: Discussionsupporting

confidence: 84%

Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Cairncross

Herring

Ingen

et al. 2018

cmajo

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Background: Negative health outcomes associated with the use of both prescribed and nonprescribed opioids are increasingly prevalent. We examined long-term trends in opioid-related harms in Ontario across a set of 6 indicators and the relation between harms and neighbourhood income in 2016. Methods: We examined rates of neonatal abstinence syndrome, opioid poisoning (fatal and nonfatal) and nonpoisoning opioidrelated events from 2003 to 2016 in Ontario using population-based health administrative databases. We conducted descriptive analyses for harm indicators across neighbourhood income quintiles in 2016 (2015 for death). We examined social inequalities in opioid-related harms on both relative (prevalence ratio) and absolute (potential rate reduction) scales. Results: Rates of opioid-related harms increased dramatically between 2003 and 2016. In 2016, neonatal abstinence syndrome and opioid poisoning and nonpoisoning events showed a strong social gradient, with harm rates being lowest in higher-income neighbourhoods and highest in lower-income neighbourhoods. Prevalence ratios for the lowest-income neighbourhoods compared to the highest-income neighbourhoods ranged from 2.36 (95% confidence interval [CI] 2.15-2.58) for emergency department visits for opioid poisoning to 3.70 (95% CI 2.62-5.23) for neonatal abstinence syndrome. Potential rate reductions for opioid-related harms ranged from 34.8% (95% CI 29.1-40.1) to 49.9% (95% CI 36.7-60.5), which suggests that at least one-third of all harmful events could be prevented if all neighbourhoods had the same socioeconomic profile as the highest-income neighbourhoods. Interpretation: Rates of opioid-related harms increased in Ontario between 2003 and 2016, and people in lower-income neighbourhoods experienced substantially higher rates of opioid-related harms than those in higher-income neighbourhoods. This finding can inform planning for opioid-related public health interventions with consideration of health equity.

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Section: Discussionsupporting

confidence: 84%

Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Cairncross

Herring

Ingen

et al. 2018

cmajo

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“…Of the 2.1 million initiators of opioid misuse per year in the USA, 1.2 million (57%) are women [ 1 ]. In Ontario (Canada), there was a 16-fold increase in the number of deliveries among women with substance use disorder from 2002 to 2016 [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Lack of available substance use treatment has historically been problematic for users wanting to engage in care, and this has been further challenged by the ongoing increases in opioid use [ 3 ]. Twenty-seven percent of women with opioid use disorder in Ontario who delivered from 2002 to 2014 did not have a prescription record of opioid agonist therapy [ 2 ]. In the USA in 2016, almost nine out of ten young adults and eight out of ten of adults aged 26 or older who needed treatment for illicit drug use did not receive specialty treatment [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Need for women-centered treatment for substance use disorders: results from focus group discussions

Elms

Link²,

Newman

et al. 2018

Harm Reduct J

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BackgroundThere are few women-centered treatment programs for substance use disorder. We therefore undertook an exploratory study to better understand the treatment experience, barriers, and facilitators of mothers with substance use disorder.MethodsWe conducted two focus groups with a total of ten women with a history of substance use disorder in Kingston (Canada). Women were recruited from a community program for mothers with substance use disorder. The focus groups were recorded, and the resulting data were transcribed, coded, and thematically analyzed. Barriers, facilitators and treatment needs were identified.ResultsThe mean age of the participants was 31.1 years, 30% were currently using substances, and 60% had a child in their care. A key concern for women regarding substance use treatment was the welfare of their child(ren). Agencies charged with child protection were a barrier to treatment because women feared disclosing substance use would result in loss of child custody. In contrast, when agencies stipulated that women must attend treatment to retain custody, they facilitated treatment engagement. Other barriers to treatment included identifying treatment programs and completing admission requirements, wait times, counselor ability to address woman-centered issues, fear, safety, and stigma. Women’s personal motivation for treatment was a facilitator. Suggestions to improve treatment programs included to allow children to accompany their mothers, involvement of peer support, and women-only programs.ConclusionsThis small but novel study provides important data to inform treatment programming for mothers with substance use disorders.

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“…2 This epidemic includes pregnant women, with the number of infants born to opioiddependent women in Ontario increasing from 46 in 2002 to almost 800 in 2014 of a total of 4336 deliveries by opioid-dependent mothers in the 12-year period. 3 Data on prevalence of opioid exposure during pregnancy in urban Ontario cohorts are lacking, however, prevalence in northern and rural Ontario has been reported to be as high as 27.8%. In the above-cited study, information on maternal drug use was collected using a standard case report form, and further characterized using urine drug screen results.…”

Section: Introductionmentioning

confidence: 99%

Maternal and neonatal characteristics of a Canadian urban cohort receiving treatment for opioid use disorder during pregnancy

Miller

Grynspan

Gaudet

et al. 2018

J Dev Orig Health Dis

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The epidemic of prescription and non-prescription opioid misuse is of particular importance in pregnancy. The Society of Obstetricians and Gynaecologists of Canada currently recommends opioid replacement therapy with methadone or buprenorphine for opioid-dependent women during pregnancy. This vulnerable segment of the population has been shown to be at increased risk of blood-borne infectious diseases, nutritional insecurity and stress. The objective of this study was to describe an urban cohort of pregnant women on opioid replacement therapy and to evaluate potential effects on the fetus. A retrospective chart review of all women on opioid replacement therapy and their infants who delivered at The Ottawa Hospital General and Civic campuses between January 1, 2013 and March 24, 2017 was conducted. Data were collected on maternal characteristics, pregnancy outcomes, neonatal outcomes and corresponding placental pathology. Maternal comorbidities identified included high rates of infection, tobacco use and illicit substance use, as well as increased rates of placental abruption compared with national averages. Compared with national baseline averages, the mean neonatal birth weight was low, and the incidence of small for gestational age infants and congenital anomalies was high. The incidence of NAS was comparable with estimates from other studies of similar cohorts. Findings support existing literature that calls for a comprehensive interdisciplinary risk reduction approach including dietary, social, domestic, psychological and other supports to care for opioid-dependent women in pregnancy.

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Infants Born to Opioid-Dependent Women in Ontario, 2002–2014

Cited by 50 publications

References 27 publications

Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Relation between opioid-related harms and socioeconomic inequalities in Ontario: a population-based descriptive study

Need for women-centered treatment for substance use disorders: results from focus group discussions

Maternal and neonatal characteristics of a Canadian urban cohort receiving treatment for opioid use disorder during pregnancy

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