Grant: Planning and Dissemination Grant - Institute Community Support

Northwestern Ontario has very high rates of opioid dependence in pregnancy exceeding twenty percent in some communities. The gold standard for managing opioid dependence in pregnancy is methadone maintenance therapy (MMT). Numerous studies show MMT is associated with improved pregnancy outcomes, increased rates of infant discharge home with the mother and decreased rates of relapse compared to no treatment or to detoxification. However, logistical limitations prohibit its use in many rural and remote locations and some First Nations communities are reluctant to introduce methadone due to the risks and stigma associated with its use. An alternative to MMT is buprenorphine maintenance therapy, which also reduces withdrawal symptoms in the neonate but it is very difficult to obtain. Opioid detoxification in pregnancy results in low rates of neonatal withdrawal, but high rates of relapse unless ongoing treatment is available. In spite of the challenges providing treatment for opioid dependence in pregnancy there are no consensus guidelines to standardize care. This leads to wide variation in practice and often little to no continuity of care if the woman requires services outside of her community. The objective of this meeting is to bring together clinicians who care for women with opioid dependence in pregnancy and their infants in order to share medical management strategies and clinical care tools. The results of this discussion will lead to the development of shared, regional clinical care pathways as well as the identification of clinical and research priorities in the area of medical management of opioid dependence in pregnancy. In addition, clinical experts from established provincial and national addiction in pregnancy programs will be present to share their experience managing integrated health care approaches and to provide mentorship to the Northwestern Ontario Clinicians.