title: Integrated care for pregnant women on methadone maintenance treatment: Canadian primary care cohort study.
abstract: OBJECTIVE
  To describe the characteristics of a national cohort of pregnant women on methadone maintenance treatment (MMT) and to provide treatment outcome data for integrated care programs.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Three different integrated care programs in geographically distinct cities: the Toronto Centre for Substance Use in Pregnancy in Toronto, Ont; the Herzl Family Practice Centre in Montreal, Que; and the Sheway clinic in Vancouver, BC.
  
  
  METHODS
  Pregnant women meeting criteria for opioid dependence and attending an integrated care program between 1997 and 2009. Women were excluded if they were on MMT only for chronic pain.
  
  
  METHODS
  Patient demographic characteristics, concurrent medical and psychiatric disorders, and substance use outcome data.
  
  
  RESULTS
  A total of 102 opioid-dependent pregnancies were included. The mean age was 29.7 years and 64% of women were white. Women in Montreal were more likely to have partners and had fewer children. Differences in living and housing situations among the sites tended to resolve by the time of delivery. Almost half of this cohort tested positive for hepatitis C. Women had a high prevalence of depression and anxiety across all sites. Half of this cohort was on MMT before conception and for the other half, MMT was initiated at a mean gestational age of 20.7 weeks, resulting in a mean dose of 82.4 mg at delivery. At the first visit, polysubstance use was common. Prescription opioid use was more frequent in Toronto and heroin use was more prevalent in Vancouver and Montreal. For the entire population, significant reductions were found by the time of delivery for illicit (P < .001) and prescription opioids (P = .001), cocaine (P < .001), marijuana (P = .009), and alcohol use (P < .001).
  
  
  CONCLUSIONS
  Despite geographic differences, all 3 integrated care programs have been associated with significant decreases in substance use in pregnant opioid-dependent women.
authors.affiliation: Department of Family Medicine, St Joseph's Health Centre, 30 The Queensway, Toronto, ON M6R 1B5. ordeaa@stjoe.on.ca.
authors.forename: Alice
authors.initials: A
authors.lastname: Ordean
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.forename: Lisa
authors.initials: L
authors.lastname: Graves
authors.forename: Ronald
authors.initials: R
authors.lastname: Abrahams
authors.forename: Talar
authors.initials: T
authors.lastname: Boyajian
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002170:Canada; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000534:rehabilitation*; D011320:Primary Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone