Rising neonatal opioid withdrawal
Between 1992 and 2011, the incidence of neonatal abstinence syndrome increased 15-fold in Ontario, from 0.28 per 1000 live births to 4.29 (Figure 1). In this retrospective study, the authors also looked at the degree to which treatment of maternal pain with opioids, rather than misuse of prescription opioids or heroin, contributed to this rise. During the final five years of the study, about two-thirds of mothers eligible to receive publicly funded prescription drugs and who had given birth to a baby with neonatal abstinence syndrome had received an opioid prescription in the 100 days before delivery. Just over half had received a prescription for methadone. The proportion of women with prescriptions for methadone increased as they approached delivery, while prescriptions for other opioids decreased, suggesting recognition and treatment of opioid dependence. Because the incidence of neonatal opioid withdrawal in Ontario has increased so substantially, the authors stress that strategies are needed to reduce the incidence of this serious condition. CMAJ Open 2015;3:E55-61
Figure 1:
Annual incidence of neonatal abstinence syndrome (NAS) Ontario, 1992–2011.
Dual screening for hepatitis C virus and colorectal cancer
Because many patients with hepatitis C virus (HCV) infection are unaware that they have been infected, some jurisdictions have called for birth-cohort screening (particularly among those born between 1945 and 1965), along with risk factor–based screening. Since many people undergoing colonoscopy for colorectal cancer screening fall into the target birth cohort, the authors looked at whether screening for both conditions together would be feasible. Patients (n = 1012) presenting to the Forzani and MacPhail Colon Cancer Screening Centre in Calgary, Alberta completed a survey about screening for HCV, and 483 stored serum specimens were tested for anti-HCV antibodies. Most (90%) of those surveyed would be agreeable to screening for HCV (Table 1); however, testing of the sera showed that the prevalence of HCV in this population was low (0.8%, 95% confidence interval 0.2%–2.4%). Even though acceptance of screening for HCV is high among patients undergoing screening for colorectal cancer, the low prevalence suggests that the cost-effectiveness of this approach warrants evaluation before widespread adoption. CMAJ Open 2015;3:E62-67.
Table 1:
Characteristics of patients referred for colorectal cancer screening by willingness to undergo screening for HCV
| Variable* | Total cohort, no. (%)† n = 1012 |
Unadjusted OR for willingness to be screened (95% CI)‡ |
|---|---|---|
| Male | 529 (52.3) | 1.09 (0.74–1.59) |
| Age, yr, median (IQR) | 56 (53–62) | 0.99 (0.96–1.02) |
| Baby boomer (born 1945–1965) | 914 (90.5) | 0.81 (0.38–1.73) |
| White | 876 (87.1) | 4.25 (2.66–6.79) |
| Born outside of Canada | 221 (21.9) | 0.34 (0.22–0.52) |
| HCV risk factors | ||
| 0 | 746 (73.7) | Ref |
| 1 | 169 (16.7) | 2.69 (1.28–5.66) |
| ≥ 2 | 97 (9.6) | 4.18 (1.30–13.5) |
Note: CI = confidence interval, HCV = hepatitis C virus, IQR = interquartile range, OR = odds ratio.
Number of respondents missing for the following variables: sex (n = 1), age (n = 2), race (n = 6), immigration status (n = 1), marital status (n = 5) and education level (n = 69).
Unless otherwise specified.
Excludes 9 patients with a self-reported diagnosis of HCV.