(283) Opioid Toxicity in the Year After Pregnancy Among Women with Disabilities

Background: Pregnancy-associated deaths from synthetic opioid use accounts for 10% of deaths within 1 year of pregnancy. While women with disabilities have higher rates of opioid use, their risk of opioid toxicity after pregnancy is unknown.

Objectives: To examine the risk of opioid toxicity in the year after pregnancy in women with a disability, and identify factors associated with opioid toxicity in that population.

Methods: This population-based cohort study was completed in Ontario, Canada. Included were all pregnancies (i.e., livebirths, stillbirths, induced abortions, miscarriages) in 2012-2021. Included were 207,318 women with a physical, sensory, or intellectual/developmental disability, who were compared to 1,298,400 women without a disability. Cox proportional hazards regression models generated adjusted hazard ratios (aHR) for opioid toxicity comparing those with vs. without a disability. Among those women with a disability, aHRs were then generated for the relationship between common sociodemographic, clinical, and pharmacologic factors and the risk of opioid toxicity.

Results: Opioid toxicity occurred at a rate of 0.34 per 100,000 person-days in those with a disability vs. 0.13 per 100,000 person-days in those without a disability – an aHR of 1.32 (95% CI 1.13-1.54). Among women with a disability, low-income neighbourhood residence (aHR 2.47, 1.41-4.33), social disadvantage (aHR 2.98, 95% CI 2.21-4.03), a non-disability pain condition (aHR 1.52, 95% CI 1.17-1.97), mental illness (aHR 1.63, 95% CI 1.23-2.18), substance use disorder in the preceding 2 years (aHR 8.25, 95% CI 5.89-11.54), prenatal opioid use (aHR 3.28, 95% CI 2.4--4.47), prenatal benzodiazepine use (aHR 1.56, 95% CI 1.11-2.19), induced abortion (aHR 2.77, 95% CI 1.95-3.93), pregnancy loss (aHR 2.56, 95% CO 1.77-3.71), and infant discharge to social services at birth (aHR 2.77, 95% CI 1.78-4.32) were each associated with an elevated risk of opioid toxicity.

Conclusions: These findings suggest a need for comprehensive, accessible harm reduction services and preventive efforts in certain women with a disability who also have identifiable risk factors for opioid toxicity.