Incidence of narcotic abuse during pregnancy in northwestern Ontario: three-year prospective cohort study.

OBJECTIVE To document the incidence and outcomes of narcotic use during pregnancy in northwestern Ontario. DESIGN Three-year prospective cohort study. SETTING Sioux Lookout and surrounding communities in northwestern Ontario. PARTICIPANTS A total of 1206 consecutive births in a catchment area of 28 000 First Nations patients. MAIN OUTCOME MEASURES Incidence of narcotic use, and maternal and neonatal outcomes. RESULTS Incidence of narcotic use in pregnancy has risen to 28.6% (P < .001) and incidence of neonatal abstinence syndrome has fallen to 18.0% of narcotic-exposed births (P = .003). Daily intravenous drug use is now a common pattern of abuse. CONCLUSION Narcotic abuse in pregnancy has dramatically increased in northwestern Ontario. Neonatal outcomes have improved as a result of a family medicine-based prenatal and obstetric program that includes a narcotic replacement and tapering program.