摘要：Communities in Northwestern Ontario began experiencing an epidemic of opioid misuse over 10 years ago. The Truth and Reconciliation Commission acknowledged that substance use is a symptom of the ongoing suffering experienced by Canada's Indigenous peoples through colonial institutions and policies such as the residential school system. (1) In 2009, the Nishnawbe Aski Nation Chiefs-in-Assembly declared a state of emergency for prescription drug abuse in all of its 49 communities (2) as rates of opioid use were estimated to reach 50%-80% of the population. (3) Given the prevalence of opioid use in rural and remote First Nations communities, it is not surprising that a significant proportion of reproductive-aged women become pregnant while using opioids.
Northwestern Ontario has over 2500 deliveries each year with 40% of the deliveries occurring in the region and 60% in Thunder Bay. (4) The prevalence of opioid use in pregnancy varies throughout the region. At Lake of the Woods Hospital in Kenora, a centre with 240 births in 2013, (4) opioid exposure is present in 3% of pregnancies. (5) At Sioux Lookout Meno Ya Win Health Centre, which had approximately 450 births in 2014, (4) the prevalence of opioid use in pregnancy has risen from 8% in 2009 to 18% in 2011, and to 28% in 2014. (6-9) A similar pattern was seen at the Thunder Bay Regional Health Sciences Centre, which has approximately 1500 births annually. (4,10)
Recent data on the pattern of use has shown that just under half of opioid-using pregnant women are now daily users of opioids and the most common opioid remains long-acting oxycodone. (8) The route of administration has also shifted from oral and intranasal use (snorting) early in the epidemic to injection drug use in up to one third of opioid-using pregnant women by 2013. (8) The individual and public health implications associated with a shift towards injection drug use are considerable.
