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Article ; Online: Commentary on Krans et al.: Outcomes associated with the use of medications for opioid use disorder during pregnancy.

Schmidt, Rose A

2022 Volume 117, Issue 6, Page(s) 1818–1819

MeSH term(s)	Buprenorphine/therapeutic use ; Female ; Humans ; Opioid-Related Disorders/drug therapy ; Pregnancy
Chemical Substances	Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2022-02-14
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	1141051-6
ISSN	1360-0443 ; 0965-2140
ISSN (online)	1360-0443
ISSN	0965-2140
DOI	10.1111/add.15830
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Article ; Online: A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy.

Schmidt, Rose A / Everett, Karl / Perez-Brumer, Amaya / Strike, Carol / Rush, Brian / Gomes, Tara

Addiction (Abingdon, England)

2024 Volume 119, Issue 6, Page(s) 1111–1122

Abstract: Background and aims: Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on ...

Abstract	Background and aims: Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. Design: This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. Setting and participants: The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. Measurements: We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. Findings: Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). Conclusion: Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.
MeSH term(s)	Humans ; Female ; Pregnancy ; Ontario/epidemiology ; Methadone/therapeutic use ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Opiate Substitution Treatment/methods ; Pregnancy Complications/drug therapy ; Pregnancy Complications/epidemiology ; Adult ; COVID-19/epidemiology ; Buprenorphine/therapeutic use ; Analgesics, Opioid/therapeutic use ; Buprenorphine, Naloxone Drug Combination/therapeutic use ; Narcotic Antagonists/therapeutic use
Chemical Substances	Methadone (UC6VBE7V1Z) ; Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid ; Buprenorphine, Naloxone Drug Combination ; Narcotic Antagonists
Language	English
Publishing date	2024-03-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1141051-6
ISSN	1360-0443 ; 0965-2140
ISSN (online)	1360-0443
ISSN	0965-2140
DOI	10.1111/add.16459
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Article ; Online: Examining barriers to harm reduction and child welfare services for pregnant women and mothers who use substances using a stigma action framework.

Wolfson, Lindsay / Schmidt, Rose A / Stinson, Julie / Poole, Nancy

Health & social care in the community

2021 Volume 29, Issue 3, Page(s) 589–601

Abstract: Pregnant women and mothers who use substances often face significant barriers to accessing and engaging with substance use services. A scoping review was conducted in 2019 to understand how stigma impacts access to, retention in and outcomes of harm ... ...

Abstract	Pregnant women and mothers who use substances often face significant barriers to accessing and engaging with substance use services. A scoping review was conducted in 2019 to understand how stigma impacts access to, retention in and outcomes of harm reduction and child welfare services for pregnant women and mothers who use substances. The forty-two (n = 42) articles were analysed using the Action Framework for Building an Inclusive Health System developed by Canada's Chief Public Health Officer to articulate the ways in which stigma and related health system barriers are experienced at the individual, interpersonal, institutional and population levels. Many articles highlighted barriers across multiple levels, 19 of which cited barriers at the individual level (i.e., fear and mistrust of child welfare services), 18 at the interpersonal level (i.e., familial and relational influence on accessing substance use treatment), 30 at the institutional level (i.e., high organisational expectations on women) and 17 at the population level (i.e., negative stereotypes and racism). Our findings highlight the interconnectedness of stigma and related barriers and the ways in which stigma at the institutional and population levels pervasively influence individual and interpersonal experiences of stigma. Despite a wealth of literature on barriers to treatment and support for pregnant women and mothers who use substances, there has been minimal focus on how systems can address these formidable barriers. This review highlights the ways in which the barriers are connected and identifies opportunities for service providers and policymakers to better support pregnant women and mothers who use substances.
MeSH term(s)	Child ; Child Welfare ; Female ; Harm Reduction ; Humans ; Mothers ; Pregnancy ; Pregnant Women ; Social Stigma
Language	English
Publishing date	2021-03-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	1155902-0
ISSN	1365-2524 ; 0966-0410
ISSN (online)	1365-2524
ISSN	0966-0410
DOI	10.1111/hsc.13335
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Article ; Online: Trauma-Informed Approaches in Healthcare Ethics Consultation: A Missing Element in Healthcare for People Who Use Drugs during the Overdose Crisis?

Guta, Adrian / Buchman, Daniel Z / Schmidt, Rose A / Perri, Melissa / Strike, Carol

The American journal of bioethics : AJOB

2022 Volume 22, Issue 5, Page(s) 68–70

MeSH term(s)	Bioethics ; Delivery of Health Care/ethics ; Ethics Consultation ; Health Facilities ; Humans
Language	English
Publishing date	2022-04-27
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2060433-6
ISSN	1536-0075 ; 1526-5161
ISSN (online)	1536-0075
ISSN	1526-5161
DOI	10.1080/15265161.2022.2055208
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Article ; Online: COVID-19 and the opportunity for gender-responsive virtual and remote substance use treatment and harm reduction services.

Perri, Melissa / Schmidt, Rose A / Guta, Adrian / Kaminski, Nat / Rudzinski, Katherine / Strike, Carol

The International journal on drug policy

2022 Volume 108, Page(s) 103815

Abstract: The COVID-19 pandemic has increased the uptake of virtual and remote service delivery in the substance use field, which was previously uncommon. This swift uptake of virtual services provides an opportunity to improve service design to meet the diverse ... ...

Abstract	The COVID-19 pandemic has increased the uptake of virtual and remote service delivery in the substance use field, which was previously uncommon. This swift uptake of virtual services provides an opportunity to improve service design to meet the diverse needs of women and gender-diverse people. Such services have the potential to better meet the needs of women and gender-diverse people by allowing for increased choice, control, and autonomy, enabling empowerment, facilitating greater considerations of power relations, violence, childcare responsibilities, and fostering greater inclusion of trans and non-binary people. This commentary aims to identify how virtual and remote delivery of substance use treatment and harm reduction services can be gender-responsive. We highlight the role gender transformative services play in meeting the unique needs of women and gender-diverse people who use drugs both during and after the COVID-19 pandemic. By using the unique window of opportunity COVID-19 has created to develop and deliver gender-transformative programs, we can help address the detrimental gaps in service accessibility and effectiveness that have persistently been experienced by women and gender-diverse people who use drugs.
MeSH term(s)	COVID-19 ; Female ; Gender Identity ; Harm Reduction ; Humans ; Pandemics ; Substance-Related Disorders/therapy
Language	English
Publishing date	2022-08-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2010000-0
ISSN	1873-4758 ; 0955-3959
ISSN (online)	1873-4758
ISSN	0955-3959
DOI	10.1016/j.drugpo.2022.103815
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Article ; Online: Impact of safer supply programs on injection practices: client and provider experiences in Ontario, Canada.

Gagnon, Marilou / Rudzinski, Katherine / Guta, Adrian / Schmidt, Rose A / Kryszajtys, David T / Kolla, Gillian / Strike, Carol

Harm reduction journal

2023 Volume 20, Issue 1, Page(s) 81

Abstract: Objectives: Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and ... ...

Abstract	Objectives: Fentanyl has contributed to a sharp rise in the toxicity of the unregulated drug supply and fatal overdoses in Canada. It has also changed injection practices. Injection frequency has increased as a result and so has equipment sharing and health-related risks. The aim of this analysis was to explore the impact of safer supply programs on injection practices from the perspective of clients and providers in Ontario, Canada. Methods: The data set included qualitative interviews with 52 clients and 21 providers that were conducted between February and October 2021 across four safer supply programs. Interview excerpts discussing injection practices were extracted, screened, coded and then grouped into themes. Results: We identified three themes, each theme corresponding to a change in injection practices. The first change was a decrease in the amount of fentanyl used and a decrease in injection frequency. The second change involved switching to injecting hydromorphone tablets instead of fentanyl. Finally, the third change was stopping injecting altogether and taking safer supply medications orally. Conclusion: Safer supply programs can contribute to reducing injection-related health risks in addition to overdose risks. More specifically, they have the potential to address disease prevention and health promotion gaps that stand-alone downstream harm reduction interventions cannot address, by working upstream and providing a safer alternative to fentanyl.
MeSH term(s)	Humans ; Ontario ; Drug Overdose/prevention & control ; Fentanyl ; Harm Reduction ; Health Promotion
Chemical Substances	Fentanyl (UF599785JZ)
Language	English
Publishing date	2023-06-28
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2146691-9
ISSN	1477-7517 ; 1477-7517
ISSN (online)	1477-7517
ISSN	1477-7517
DOI	10.1186/s12954-023-00817-7
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Article ; Online: The early impact of COVID-19 on the incidence, prevalence, and severity of alcohol use and other drugs: A systematic review.

Schmidt, Rose A / Genois, Rosalie / Jin, Jonathan / Vigo, Daniel / Rehm, Jürgen / Rush, Brian

Drug and alcohol dependence

2021 Volume 228, Page(s) 109065

Abstract: Background: The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems.: Method: A systematic review of literature published up to March 2021 was ... ...

Abstract	Background: The aim of this paper was to examine the early impact of COVID-19 on substance use to assess implications for planning substance use treatment and support systems. Method: A systematic review of literature published up to March 2021 was conducted to summarize changes in prevalence, incidence, and severity of substance use associated with COVID-19 and the accompanying public health measures, including lockdown, stay-at-home orders, and social distancing. Results: We identified 53 papers describing changes to substance use at the population level. The majority of papers described changes related to alcohol use and most relied on self-reported measures of consumption during the COVID-19 pandemic, compared with pre-pandemic use. There was less evidence to support changes in non-alcohol substance use. In general, risky pre-pandemic alcohol use, caregiving responsibilities, stress, depression, anxiety, and current treatment for a mental disorder were found to be associated with increased substance use. Conclusion: This review provides preliminary data on changes in substance use, indicating that certain segments of the population increased their alcohol use early on in the COVID-19 pandemic and may be at greater risk of harm and in need of additional services. There is a need for additional population-level information on substance use to inform evidence-based rapid responses from a treatment system perspective.
MeSH term(s)	COVID-19 ; Communicable Disease Control ; Humans ; Incidence ; Pandemics ; Pharmaceutical Preparations ; Prevalence ; SARS-CoV-2
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2021-09-22
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2021.109065
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Article ; Online: A harmonized analysis of five Canadian pregnancy cohort studies: exploring the characteristics and pregnancy outcomes associated with prenatal alcohol exposure.

Schmidt, Rose A / Wey, Tina W / Harding, Kelly D / Fortier, Isabel / Atkinson, Stephanie / Tough, Suzanne / Letourneau, Nicole / Knight, Julia A / Fraser, William D / Bocking, Alan

BMC pregnancy and childbirth

2023 Volume 23, Issue 1, Page(s) 128

Abstract: Background: As a teratogen, alcohol exposure during pregnancy can impact fetal development and result in adverse birth outcomes. Despite the clinical and social importance of prenatal alcohol use, limited routinely collected information or ... ...

Abstract	Background: As a teratogen, alcohol exposure during pregnancy can impact fetal development and result in adverse birth outcomes. Despite the clinical and social importance of prenatal alcohol use, limited routinely collected information or epidemiological data exists in Canada. The aim of this study was to pool data from multiple Canadian cohort studies to identify sociodemographic characteristics before and during pregnancy that were associated with alcohol consumption during pregnancy and to assess the impact of different patterns of alcohol use on birth outcomes. Methods: We harmonized information collected (e.g., pregnant women's alcohol intake, infants' gestational age and birth weight) from five Canadian pregnancy cohort studies to consolidate a large sample (n = 11,448). Risk factors for any alcohol use during pregnancy, including any alcohol use prior to pregnancy recognition, and binge drinking, were estimated using binomial regressions including fixed effects of pregnancy cohort membership and multiple maternal risk factors. Impacts of alcohol use during pregnancy on birth outcomes (preterm birth and low birth weight for gestational) were also estimated using binomial regression models. Results: In analyses adjusting for multiple risk factors, women's alcohol use during pregnancy, both any use and any binge drinking, was associated with drinking prior to pregnancy, smoking during pregnancy, and white ethnicity. Higher income level was associated with any drinking during pregnancy. Neither drinking during pregnancy nor binge drinking during pregnancy was significantly associated with preterm delivery or low birth weight for gestational age in our sample. Conclusions: Pooling data across pregnancy cohort studies allowed us to create a large sample of Canadian women and investigate the risk factors for alcohol consumption during pregnancy. We suggest that future pregnancy and birth cohorts should always include questions related to the frequency and amount of alcohol consumed before and during pregnancy that are prospectively harmonized to support data reusability and collaborative research.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Infant ; Female ; Humans ; Pregnancy Outcome/epidemiology ; Premature Birth/epidemiology ; Premature Birth/etiology ; Binge Drinking/epidemiology ; Canada/epidemiology ; Prenatal Exposure Delayed Effects/epidemiology ; Cohort Studies ; Ethanol
Chemical Substances	Ethanol (3K9958V90M)
Language	English
Publishing date	2023-02-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-023-05447-2
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Article ; Online: Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients' perspectives on wraparound programming.

Rutman, Deborah / Hubberstey, Carol / Poole, Nancy / Schmidt, Rose A / Van Bibber, Marilyn

BMC pregnancy and childbirth

2020 Volume 20, Issue 1, Page(s) 441

Abstract: Background: In Canada, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged. These programs offer basic needs and social supports along with perinatal, ...

Abstract	Background: In Canada, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged. These programs offer basic needs and social supports along with perinatal, primary, and mental health care, as well as substance use services. Evaluations of these 'one-stop' programs have demonstrated positive outcomes; nevertheless, few published studies have focused on how these programs are structured, on their cross-sectoral partnerships, and on clients' perceptions of their services. Methods: The Co-Creating Evidence (CCE) project was a three-year evaluation of eight multi-service programs located in six Canadian jurisdictions. The study used a mixed-methods design involving semi-structured interviews, questionnaires, output data, and de-identified client data. This article focuses on qualitative interviews undertaken with 125 clients during the first round of site visits, supplemented by interview data with program staff and service partners. Results: Each of the programs in the CCE study employs a multi-service model that both reflects a wrap-around approach to care and is intentionally geared to removing barriers to accessing services. The programs are either operated by a health authority (n = 4) or by a community-based agency (n = 4). The programs' focus on the social determinants of health, and their provision of primary, prenatal, perinatal and mental health care services is essential; similarly, on-site substance use and trauma/violence related services is pivotal. Further, programs' support in relation to women's child welfare issues promotes collaboration, common understanding of expectations, and helps to prevent child/infant removals. Conclusions: The programs involved in the Co-Creating Evidence study have impressively blended social and primary care and prenatal care. Their success in respectfully and flexibly responding to women's diverse needs, interests and readiness, within a community-based, wraparound service delivery model paves the way for others offering pre- and postnatal programming.
MeSH term(s)	Adult ; Attitude to Health ; Canada ; Child Welfare ; Child, Preschool ; Counseling ; Delivery of Health Care, Integrated/methods ; Female ; Humans ; Infant ; Infant, Newborn ; Interdisciplinary Communication ; Parents/psychology ; Patient Care Team ; Pregnancy ; Social Support ; Substance-Related Disorders/psychology ; Substance-Related Disorders/therapy ; Surveys and Questionnaires ; Women's Health ; Young Adult
Language	English
Publishing date	2020-08-03
Publishing country	England
Document type	Evaluation Study ; Journal Article
ZDB-ID	2059869-5
ISSN	1471-2393 ; 1471-2393
ISSN (online)	1471-2393
ISSN	1471-2393
DOI	10.1186/s12884-020-03109-1
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Article ; Online: The Potential for Fetal Alcohol Spectrum Disorder Prevention of a Harmonized Approach to Data Collection about Alcohol Use in Pregnancy Cohort Studies.

Poole, Nancy / Schmidt, Rose A / Bocking, Alan / Bergeron, Julie / Fortier, Isabel

International journal of environmental research and public health

2019 Volume 16, Issue 11

Abstract: Prenatal alcohol exposure is a leading cause of disability, and a major public health concern in Canada. There are well-documented barriers for women and for service providers related to asking about alcohol use in pregnancy. Confidential research is ... ...

Abstract	Prenatal alcohol exposure is a leading cause of disability, and a major public health concern in Canada. There are well-documented barriers for women and for service providers related to asking about alcohol use in pregnancy. Confidential research is important for learning about alcohol use before, during and after pregnancy, in order to inform fetal alcohol spectrum disorder (FASD) prevention strategies. The Research Advancement through Cohort Cataloguing and Harmonization (ReACH) initiative provides a unique opportunity to leverage the integration of the Canadian pregnancy and birth cohort information regarding women's drinking during pregnancy. In this paper, we identify: The data that can be collected using formal validated alcohol screening tools; the data currently collected through Canadian provincial/territorial perinatal surveillance efforts; and the data currently collected in the research context from 12 pregnancy cohorts in the ReACH Catalogue. We use these findings to make recommendations for data collection about women's alcohol use by future pregnancy cohorts, related to the frequency and quantity of alcohol consumed, the number of drinks consumed on an occasion, any alcohol consumption before pregnancy, changes in use since pregnancy recognition, and the quit date. Leveraging the development of a Canadian standard to measure alcohol consumption is essential to facilitate harmonization and co-analysis of data across cohorts, to obtain more accurate data on women's alcohol use and also to inform FASD prevention strategies.
MeSH term(s)	Adult ; Alcohol Drinking/epidemiology ; Canada/epidemiology ; Cohort Studies ; Data Collection/methods ; Female ; Fetal Alcohol Spectrum Disorders/epidemiology ; Humans ; Pregnancy ; Prenatal Exposure Delayed Effects/prevention & control ; Research/organization & administration ; Research/standards
Language	English
Publishing date	2019-06-06
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph16112019
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