Abstract
Opioid use affects up to 30% of pregnancies in Northwestern Ontario. Health care providers in Northwestern Ontario have varying comfort levels providing care to substance-involved pregnant women. Furthermore, health care practitioners, social service agencies and community groups in Northwestern Ontario often work in isolation with little multidisciplinary communication and collaboration. This article describes two workshops that brought together health and social service providers, community organizations, as well as academic institutions and professional organizations involved in the care of substance-involved pregnant and parenting women. The initial workshop presented best practices and local experience in the management of opioid dependence in pregnancy while the second workshop asked participants to apply a local Indigenous worldview to the implementation of clinical, research and program priorities that were identified in the first workshop. Consensus statements developed by workshop participants identified improved transitions in care, facilitated access to buprenorphine treatment, stable funding models for addiction programs and a focus on Indigenous-led programming. Participants identified a critical need for a national strategy to address the effects of opioid use in pregnancy from a culturally safe, trauma-informed perspective that takes into account the health and well-being of the woman, her infant, her family and her community.
Key words: Opiate dependence, pregnancy, Indigenous health services, rural population
Résumé
La consommation d’opioïdes affecte jusqu’à 30 % des grossesses dans le Nord-Ouest de l’Ontario. Le personnel soignant du Nord-Ouest ontarien est plus ou moins à l’aise d’offrir des soins aux femmes enceintes qui consomment des substances. De plus, les professionnels de la santé, les services sociaux et les groupes communautaires du Nord-Ouest de l’Ontario travaillent souvent isolément et ont peu de communications et de liens de collaboration multidisciplinaires. Notre article décrit deux ateliers qui ont rassemblé des dispensateurs de services sociaux et de santé, des organismes communautaires, des établissements d’enseignement et des associations professionnelles intervenant dans les soins aux femmes enceintes et aux mères qui consomment des substances. Le premier atelier a présenté des pratiques exemplaires et l’expérience locale de prise en charge de la dépendance aux opioïdes durant la grossesse; dans le second, les participants ont appliqué une vision du monde autochtone locale à la mise en œuvre des priorités (cliniques, de recherche et de programme) définies durant le premier atelier. Les déclarations de consensus élaborées par les participants ont mentionné l’amélioration des transitions dans les soins, la facilitation de l’accès au traitement à la buprenorphine, des modèles de financement stables pour les programmes de lutte contre les toxicomanies et un accent sur les programmes dirigés par les Autochtones. Les participants ont défini le besoin urgent d’une stratégie nationale pour aborder les effets de la consommation d’opioïdes pendant la grossesse selon une perspective culturellement sûre et sensible aux traumatismes, qui tienne compte de la santé et du bien-être de la femme, de son nourrisson, de sa famille et de sa communauté.
Mots clés: dépendance aux opiacés, grossesse, services de santé autochtone, population rurale
Footnotes
Funding: The Thunder Bay Regional Health Research Institute and the Sioux Lookout Meno Ya Win Health Centre supported the initial workshop. The second workshop was supported by the Canadian Institutes of Health Research and the Centre for Rural and Northern Health Research at Lakehead University.
Conflict of Interest: None to declare.
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