The evolving nature of narcotic use in northwestern Ontario.

Narcotic use in pregnancy has been a noticeable clinical development con­ fronting the nursing and medical staff at the Sioux Lookout Meno Ya Win Health Centre.3 This regional mater­ nity centre provides prenatal services and obstetric services to a catchment area of 28 000 primarily First Nations people.4 The services include 400 de­ liveries annually. Narcotic use during pregnancy became a clinical issue in early 2009 as clinicians noted an increasing trend.3 Rates of narcotic use in pregnancy, measured over 3 consecutive 6­month periods, went from 8.4% to 17.2% and averaged out to 13.0% (Table 1).3 Neo­ natal abstinence syndrome (NAS) affected 29.5% of these narcotic­ exposed pregnancies. The clinical response included development of the nursing and medical expertise for rec­ ognition and management of narcotic use in pregnancy and subsequent neo­ natal withdrawal, when it occurred.7 The clinicians also developed an inte­ grated prenatal program, in which routine prenatal care, narcotic man­ agement and narcotic ordering took place in a single setting. Male partners were also encouraged to attend to receive addiction services, if needed (30 received treatment in 2012–2013).5 Because NAS was a clinical con­ cern, and stressful for affected neo­ nates and families, one of the aims of the integrated prenatal program was to encourage safe narcotic tapering, or weaning, whenever possible, to decrease the incidence of NAS.6 The tapering program, using a long­ acting morphine, began in January 2012 and contributed to a significant drop in the rates of NAS, without adverse neonatal outcomes.6 Rates of NAS in narcotic­exposed pregnan­ cies fell from 29.5% in 2010 to 18% in 2013 (p < 0.001). Over a 5.5­year period (2009–2014) data showed a decreasing trend (p = 0.123).6 The rate of NAS appears to have sta bil ized