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The sixth Ivey Chair Symposium, held at the University of Western Ontario in October 2011, was dedicated to an update on the complex issues surrounding opioid dependent mothers and their newborns. The day commenced with Loretta Finnegan who provided a historical overview of the complex issues surrounding the addicted mother and her baby suffering from neonatal withdrawal syndrome. It is remarkable that the tool devised by Dr Finnegan forty years ago is in wide use today, capturing accurately the severity of NAS and the need for follow up and treatment. She stressed that comprehensive approach to the care of pregnant drug-dependent mothers and their babies significantly reduces maternal and infant’s morbidity. The risk of low birth weight and severe withdrawal can be reduced substantially when both patients in this dyad are optimally cared for. The seven speakers following her provided an update on the medicinal and non drug approach to treat the opioid-dependent mother and her newborn, including new Canadian guidelines which were just released.