Research: Substance Use in Pregnant Women Using the Emergency Department: Undertested And Overlooked?


C. Leigh Moyer, BA, Sean Johnson, BS, Marilyn G. Klug, PhD, and Larry Burd, PhD

West J Emerg Med. 2018 May; 19(3): 579–584.
Published online 2018 Apr 5. doi:  10.5811/westjem.2018.1.35630


The objective was to determine if pregnant women visiting the emergency department (ED) are tested for substance use as frequently as non-pregnant women.


We captured all ED visits over a six-year period (2010–2016) from a single community hospital and identified women of childbearing age, defined for our study as 11–50 years old. We collected demographic data including age in years, ethnicity, body mass index, marital status, disposition, last encounter department, method of arrival, and day of week. An independent binary variable was created based on whether the woman was tested for alcohol or drugs (amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, opioids) during her visit. We then compared rates of testing for substance use by pregnancy status.


We identified 61,222 ED visits by women of childbearing age (range 11–50, mean 30.5, standard deviation 9.6) over a six-year period from 2010–2016. Of the 57,360 non-pregnant women, 4.14% were tested compared to 1.04% of the 3,862 pregnant women tested with a relative risk of 0.25 (p<0.001, 95% confidence interval [CI] [0.183–0.341]). The most highly tested chief complaints for all women – psychiatric or substance use concerns – showed pregnant women were still 37% and 54% less likely to be tested, respectively (risk ratio [RR] 0.46, 95% CI [0.19–1.13]; RR 0.63, 95% CI [0.41–0.96]). Beyond pregnancy status, we found no significant interaction between patient demographics and substance use testing.


Pregnant women presenting to the ED were 75% less likely to be tested for drug or alcohol use than non-pregnant women. Our study showed only pregnancy status as a statistically significant variable in drug- and alcohol-screening rates when pregnant and non-pregnant patient chief complaints and demographics were compared. Increased attention to the screening of pregnant women for substance use may be necessary to provide adequate care and intervention to this population.

To access research please visit

Mothers’ Mental Health Toolkit: A Resource For The Community

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A mother’s mental health is critical to the physical, mental, and emotional wellbeing of herself and her children. The adjustment to mothering is always a big step in a woman’s personal development. Significant mental and emotional problems are one of the most common complications of childbirth, affecting at least two in ten women.

This toolkit was developed as a public resource for community service providers and families for education, advocacy, and treatment support for mothers with mental health problems. The materials are drawn from general medical and clinical knowledge and the particular experience of the principal developers, together with a wide variety of information in the broad public realm. Included are original descriptions and writing from the author/developers. Where possible effort was made to provide specific acknowledgement of other original sources. As well, we have included general lists of references and resources, print and web-based.  

Click to download full toolkit: mmh-toolkit


The Globe and Mail: What Canada’s doctors are concerned about with marijuana legalization



As Justin Trudeau’s Liberal government tables its long-awaited marijuana legislation, Canada’s doctors have a message about pot: Just because it will eventually be legal, doesn’t mean it’s safe.

The Canadian Medical Association, the Canadian Psychiatric Association, the Canadian Paediatric Society and other organizations representing front-line health-care providers have been busy broadcasting their concerns about the ill effects of cannabis, especially for chronic smokers under the age of 25.

“We’re saying, ‘please keep the public-health focus front of mind as this legislation is unrolled,’ ” said Gail Beck, the clinical director of youth psychiatry at The Royal, a psychiatric hospital in Ottawa. “Lots of people think this is harmless.”


Explainer: Legal marijuana is coming but what does it mean for you?

The medical profession in this country has long had misgivings about medicinal marijuana – namely, that there is not enough solid evidence of pot’s efficacy in treating chronic pain and other ailments to warrant a doctor’s endorsement. But with the advent of legal recreational marijuana, doctors have a different set of worries.



One top-of-mind concern: The potential for addiction to marijuana, especially among teens and young adults. “We know that 1 in 7 teenagers who start using cannabis will develop cannabis-use disorder, which is significant,” said Christina Grant, a professor of pediatrics at McMaster University in Hamilton.

Cannabis use crosses over into disorder territory when it begins to cause dysfunction in users’ day-to-day lives, derailing their commitment to school or work and sowing conflict in their families, said Dr. Grant, the lead author of the Canadian Paediatric Society’s position statement on marijuana, released last fall.

Mental illness

Cannabis has also been linked to certain mental illnesses. The drug’s relationship to depression and anxiety is still up in the air; the science has not established a causal relationship between the two. In other words, it’s not clear if people smoke pot because they are depressed and anxious or are depressed and anxious because they smoke pot.

There is stronger evidence that heavy use of cannabis can lead to psychosis, especially among people who have a family history of mental illness, Dr. Beck said. However, the vast majority of the research involved people who use cannabis daily. The scientific literature is virtually silent on the mental-health effects of smoking pot now and then.

“We don’t know the lower limit that’s safe,” Dr. Grant cautioned. “There’s no evidence to say, yeah, use it once, use it twice and nothing will happen.”

Please click to read full article

Webinar Series, REGISTER- Health Promotion for Girls: Gender-Transformative Approaches

Date & Time: Monday June 18Time: 1:00pm ETD / 10:00AM PDT

(11:00am MDT/ 12:00pm CDT/ 2:00 pm ADT/ and 2:30 NDT)


The Presenters

Nancy Poole, Director, Centre of Excellence for Women’s Health
Marbella Carlos, Project Officer, Girls Action Foundation

This webinar will be the first of two webinars on our collaborative work to define, develop curriculum, pilot, and evaluate gender-transformative approaches to health promotion within girls’ programming. This first webinar will focus on promising practices in, and examples of, gender transformative girls’ programming. In the second webinar (to be held in the fall) we will share a new guide on this approach which has been piloted in six communities in Nova Scotia, BC, Ontario and Quebec.

We welcome all individuals and groups who are interested in girls’ group programming and girls health and wellness overall.

To register, please click

The Girls Action Foundation

At Girls Action we are committed to building a movement of active, engaged individuals and organizations across Canada. The Girls Action Foundation’s approach is based on 5 overarching principles: 1. popular education, 2. integrated feminist analysis, 3. gender specific spaces, 4. critical asset based, and 5. social action and change.

With the Centre of Excellence for Women’s Health, we have partnered on several projects about integrating health promotion approaches within girls’ empowerment group programming that is grounded in these five principles.

This webinar has been made possible by financial contribution from the Public Health Agency of Canada.  The views expressed within will not necessarily represent the view of PHAC.

For more information about this webinar contact Marbella Carlos:

Kids Brain Health Network, Mental Health Across Generations: the role of antidepressants in maternal and child wellbeing

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Existing evidence on the impact of antidepressant use during pregnancy on child development is often too mixed to offer women concrete answers about the implications for their children.

This difficult, but urgent area of research has been a long-term research interest for Network Investigator Dr. Tim Oberlander, and the focus of a Brain Canada-KBHN postdoctoral fellowship for Dr. Sarah Hutchison, who presented findings on the effects of SSRIs, on children 12 years following prenatal exposure to the common antidepressant at the Pediatric Academic Societies 2018 Meeting in May.

The KBHN-funded study found the children scored higher than controls on a task that measures thinking and attention skills. The work builds on Oberlander and colleagues’ earlier work following 51 children and their mothers since 26 weeks of pregnancy.

“The impact of prenatal antidepressant exposure is not a simple cause and effect,” says Dr. Oberlander. “When it comes to assessing the long-term impact of SSRI exposure before birth, genes and family-life also play a powerful role in influencing how a child grows and develops.

“At the core of this whole story is mother’s mental health,” adds Dr. Oberlander. “We have to talk about what it is about mother’s mental health during pregnancy that influences not only her health, but the health of her fetus and her child.”

While the full picture of antidepressants’ effect during pregnancy is far from complete, “no treatment is not an option,” observes Dr. Hutchison. “It’s important that women who are pregnant and making decisions about whether to take antidepressants or not have a discussion with their physician or midwife. That’s really the key message.”

“I want to emphasize that this is a big public health issue, and the medication part is a subset of the bigger story about pregnancy-related maternal mood disorders,” adds Dr. Oberlander. “Depression during pregnancy and after is a major public health problem that affects mothers and their children.

“The impact of maternal mental health and related medication treatment during pregnancy go on long after birth,” he adds, “and in that sense, represent an influence of mental health across two generations.”

“Further research is needed to examine whether ‘better’ cognitive skills in children with antidepressant exposure reflect a developmental advantage in some ways but also perhaps a risk in other ways, such as perhaps increased anxiety (Hanley et al, 2015),” reflects Dr. Oberlander. “Our findings when the children were 3 and 6 years of age indicated increased levels of anxiety, though the absence of this at 12 years might indicate that as executive functioning improves, children are able to help calm themselves.

“At this point we are fairly cautious in interpreting these results because data collection is ongoing,” agrees Dr. Hutchison. This is just a preliminary sample that we’ve examined so far,” adding that more research is needed before we can confidently comment on the long term consequences or benefits of this prenatal exposure.

In the end, says Dr. Oberlander, the story of this research is not one of the drugs being good or bad, or depression being good or bad. “This is must be a story of how can we support and optimize children’s developmental and mental health, even under adverse circumstances, regardless of what the particular exposure is. That’s the important thing. At a clinical level as a developmental pediatrician, my focus is really on how does this child think, act, and behave, and how can we support their development in the best ways possible, rather than saying ‘this is a population of kids that got exposed to a drug, we have to treat them in this way.’ It doesn’t work like that. It is not one size fits all.

“I hope that my work will provide a much more nuanced story that tell us about a variety of developmental outcomes and that should help us make much more precise and personal interventions for therapy.”

For more information on the SSRI  study, click here for the press release from PAS.

Retrieved from

Research: Human Drug Addiction Behaviors Tied to Specific Impairments in 6 Brain Networks


Summary: A new study reports impairments in six brain networks are associated with addiction behaviors. The findings may pave the way for developing more targeted treatments for addiction.

Source: Mount Sinai Hospital.

Specific impairments within six large-scale brain networks during drug cue exposure, decision-making, inhibitory control, and social-emotional processing are associated with drug addiction behaviors, according to a systematic review of more than 100 published neuroimaging studies by experts at the Icahn School of Medicine at Mount Sinai and published Wednesday, June 6 in the journal Neuron.

Drug addiction is a disorder that encompasses not only excessive drug-seeking and taking, but also fundamental changes in cognition and emotional processing. It comprises core clinical symptoms and behavioral manifestations including a chronically relapsing cycle of intoxication, bingeing, withdrawal, and craving that propels uncontrollable drug use despite adverse consequences and a reduction in the pleasure derived from the drug. While much of the early research on drug addiction focused on understanding the rewarding properties of the drug, recent research has made it increasingly clear that cognitive and emotional impairments support the initiation, escalation, and maintenance of the cycle of addiction. A better understanding of the underlying impaired neural mechanisms in human drug addiction is critical to paving the way for the development of more targeted, evidence-based treatment interventions and timely prevention approaches.

The Impaired Response Inhibition and Salience Attribution (iRISA) model, first published in 2002 by Rita Goldstein, PhD, Professor of Psychiatry and Neuroscience and Director of the Neuropsychoimaging of Addiction and Related Conditions research program at the Icahn School of Medicine at Mount Sinai, and Nora Volkow, Director of NIDA, proposed that impairments of two broad neuropsychological functions–response inhibition (a cognitive process that permits individuals to inhibit their impulses) and salience attribution (the property of tagging something as valuable or important)–and their underlying neural substrates contribute to the cycle of addiction across a broad range of substances of abuse.

The iRISA model uses multiple neuroimaging modalities including magnetic resonance imaging, electroencephalogram (EEG) and derived event-related potentials, positron emission tomography, and neuropsychological testing to explore the underlying neurobiology of human drug addiction and the shift to excessive salience attributed to the drug and drug-related cues at the expense of other salient reinforcers as associated with impaired self-control (especially in a drug related context) and increased drug taking in drug addicted individuals.

“We conducted the current review to update the iRISA model with the most recent evidence from the neuroimaging literature by systematically reviewing 105 task-related neuroimaging studies published since 2010,” says Dr. Goldstein, last and senior author of the paper. “We found consistent impairments in brain function in six large-scale brain networks during performance of different tasks. While the involvement of these specific brain networks was task-specific, we generally observed that in a drug-related context (e.g., during exposure to drug cues) drug addicted individuals had increased engagement of the brain networks underlying decision making, inhibitory control, and social-emotional processing, but a blunted response during non-drug related tasks, as predicted by the iRISA model.”

Please click to read the full article

Mental Health Commission of Canada: Suicide Prevention Toolkits

MHCCWhat is it  

The Mental Health Commission of Canada (MHCC), in collaboration with the Canadian Association for Suicide Prevention, the Centre for Suicide Prevention, and the Public Health Agency of Canada has developed 2 toolkits to support people who have been impacted by suicide. One toolkit is tailored for people who have attempted suicide , and the other is focused on resources for people who have lost someone to suicide . The MHCC wishes to thank the Advisory Committee comprised of people with lived experience related to suicide for their assistance in making these toolkits possible.

In the summer of 2017, the MHCC conducted an online survey to elicit feedback from people who have been affected by suicide. With over a thousand responses, the survey helped gain a better understanding of what topics, content areas, resources, and information were important to include in the toolkits.


Many respondents indicated a preference for “people-first” language as opposed to “survivorship language”. For this reason, “people-first” language is used in the toolkit. That said, many of the resources linked from the toolkits use “survivorship” language.

Please note that the toolkits are not intended to replace a conversation and are not designed to be an exhaustive list of the wide variety of resources available across Canada for support. If you or someone you know is experiencing distressing thoughts or thoughts of suicide, please contact your local distress centre or Kids Help Phone .

Please click images to download the toolkits.

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