Prescription opioid analgesic use among reproductive-aged women is prevalent in North America. Women with disabilities experience high rates of pain and structural barriers to accessing resources, potentially increasing their likelihood of opioid use and harm. Yet, few studies have examined opioid analgesic use in this population. This study compared the use of opioid pain relievers and nonmedical opioid use in reproductive-aged women with and without disabilities across Canada.
Methods:
We analyzed data from the 2018 Canadian Community Health Survey for 11,062 women aged 15–49 years. Disability status (30.6%) was determined using the Washington Group Short Set on Functioning. Modified Poisson regression was used to calculate prevalence ratios (PRs) for use of opioid pain relievers within the past 12 months, comparing women with and without disabilities, and by disability severity (mild, moderate/severe) and number of impacted functional domains (1, ≥2). Multivariable models adjusted for sociodemographic factors and health behaviors.
Results:
Women with disabilities were more likely than those without disabilities to use opioid pain relievers (19.6% versus 10.3%, adjusted prevalence ratio (aPR): 1.71, 95% confidence intervals [CI]: 1.47–1.99) and nonmedical opioids (6.2% versus 3.0%, aPR: 1.77, 95% CI: 1.28–2.43). A dose–response relationship was observed, with greater differences among women with moderate/severe disabilities and disabilities in ≥2 functional domains, compared with women without disabilities.
Interpretation:
These findings suggest a need for comprehensive education for health care providers on disability and pain management. In their early reproductive years, women with disabilities may benefit from accessible education and counseling on the risks and benefits of opioid pain relievers, with a focus on addressing social determinants of health.
ZajacovaA, Grol-ProkopczykH, LimaniM, et al.Prevalence and correlates of prescription opioid use among US adults, 2019–2020. PLoS One2023;18(3):e0282536.
2.
JannettoPJ. The North American opioid epidemic. Ther Drug Monit2021;43(1):1–5.
3.
ElmoreAL, OmofumaOO, SevoyanM, et al.Prescription opioid use among women of reproductive age in the United States: NHANES, 2003–2018. Prev Med2021;153:106846.
4.
DowellD, RaganKR, JonesCM, et al.CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022. MMWR Recomm Rep2022;71(3):1–95.
5.
GallagherBK, ShinY, RoohanP. Opioid prescriptions among women of reproductive age enrolled in medicaid—New York, 2008–2013. MMWR Morb Mortal Wkly Rep2016;65(16):415–417. Available from: https://www.cdc.gov/mmwr/volumes/65/wr/mm6516a2.htm
TurnerS, AllenVM, GravesL, et al.Guideline No. 443a: Opioid use throughout women’s lifespan: Fertility, contraception, chronic pain, and menopause. J Obstet Gynaecol Can2023;45(11):102143.
8.
WersockiE, BedsonJ, ChenY, et al.Comprehensive systematic review of long-term opioids in women with chronic noncancer pain and associated reproductive dysfunction (hypothalamic–pituitary–gonadal axis disruption). Pain2017;158(1):8–16.
9.
KeltyE, HulseG. A retrospective cohort study of birth outcomes in Neonates exposed to naltrexone in Utero: A comparison with methadone-, buprenorphine- and non-opioid-exposed Neonates. Drugs2017;77(11):1211–1219.
10.
SujanAC, QuinnPD, RickertME, et al.Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study. PLoS Med2019;16(12):e1002980.
11.
MeyerMC, JohnstonAM, CrockerAM, et al.Methadone and buprenorphine for opioid dependence during pregnancy: A retrospective cohort study. J Addict Med2015;9(2):81–86.
12.
TowersCV, KatzE, WeitzB, et al.Use of naltrexone in treating opioid use disorder in pregnancy. Am J Obstet Gynecol2020;222(1):83.e1–83.e8.
13.
CorsiDJ, HsuH, FellDB, et al.Association of Maternal Opioid Use in pregnancy with adverse perinatal outcomes in Ontario, Canada, from 2012 to 2018. JAMA Netw Open2020;3(7):e208256.
14.
HuhnAS, DunnKE. Challenges for women entering treatment for opioid use disorder. Curr Psychiatry Rep2020 Oct 31;22(12):76.
15.
HongYR, XieZ, YadavS, et al.Opioid use behaviors among people with disability in the United States: An analysis of the national survey on drug use and health. J Addict Med2023;17(1):e27–e35.
16.
EhdeDM, JensenMP, EngelJM, et al.Chronic pain secondary to disability: A review. Clin J Pain2003;19(1):3–17.
17.
FagerlundP, SalmelaJ, PietiläinenO, et al.Life-course socioeconomic circumstances in acute, chronic and disabling pain among young employees: A double suffering. Scand J Public Health2023;51(2):257–267.
SullivanMD, EdlundMJ, ZhangL, et al.Association between mental health disorders, problem drug use, and regular prescription opioid use. Arch Intern Med2006;166(19):2087–2093.
21.
KuoYF, RajiMA, GoodwinJS. Association of disability with mortality from opioid overdose among US medicare adults. JAMA Netw Open2019;2(11):e1915638.
22.
ReifS, LauerEA, AdamsRS, et al.Examining differences in prescription opioid use behaviors among U.S. adults with and without disabilities. Prev Med2021;153:106754.
23.
LauerEA, HenlyM, BruckerDL. Prescription opioid behaviors among adults with and without disabilities–United States, 2015–2016. Disabil Health J2019;12(3):519–522.
24.
DasguptaN, BeletskyL, CiccaroneD. Opioid crisis: No easy fix to its social and economic determinants. Am J Public Health2018;108(2):182–186.
25.
LundbergDJ, ChenJA. Structural ableism in public health and healthcare: A definition and conceptual framework. Lancet Regional Health - Americas [Internet]2024;30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10770745/
26.
GuanQ, MenS, LunskyY, et al.New opioid use and risk of opioid-related adverse events among adults with intellectual and developmental disabilities in Ontario, Canada. BJPsych Open2022;8(6):e208.
RichardCL, LoveBL, BoghossianN, et al.Are pregnant women with disability prescribed opioids more and at higher dosages than those without disability?: A retrospective cohort study of South Carolina Medicaid beneficiaries. Disabil Health J2022;15(2S):101288.
29.
KitsantasP, AdamsAR, CheemaJ, et al.Opioid use in pregnant women with mental health-related disabilities. Arch Gynecol Obstet2021;303(6):1531–1537.
30.
BoothEJ, KitsantasP, MinH, et al.Opioids and disability among women of reproductive age. J Womens Health (Larchmt)2022;31(12):1751–1762.
31.
ZajacovaA, SiddiqiA. A comparison of health and socioeconomic gradients in health between the United States and Canada. Soc Sci Med2022;306:115099.
32.
PylypchukY, SarpongEM. Comparison of health care utilization: United States versus Canada. Health Serv Res2013;48(2 Pt 1):560–581.
33.
FischerB. Patterns, changes, and trends in prescription opioid dispensing in Canada, 2005–2016. Pain Phys2018;1(21;1):219–228.
34.
JonesW, KaoserR, FischerB. Patterns, trends and determinants of medical opioid utilization in Canada 2005–2020: Characterizing an era of intensive rise and fall. Subst Abuse Treat Prev Policy2021;16(1):65.
GoddardKS, HallJP. Limitations of the Washington Group Short Set in capturing moderate and severe mobility disabilities. Health Aff Sch2025;3(2):qxaf015.
40.
LandesSD. Performance of the Washington Group questions in measuring blindness and deafness. 2024.
ZhaoJP, BerthodC, SheehyO, et al.Prevalence and duration of prescribed opioid use during pregnancy: A cohort study from the Quebec Pregnancy Cohort. BMC Pregnancy Childbirth2021;21(1):800.
43.
CarriereG, GarnerR, SanmartínC. Significant factors associated with problematic use of opioid pain relief medications among the household population, Canada, 2018. Health Rep2021;32(12):11–26.
44.
KozhimannilKB, GravesAJ, JarlenskiM, et al.Non-medical opioid use and sources of opioids among pregnant and non-pregnant reproductive-aged women. Drug Alcohol Depend2017;174:201–208.
45.
SmithMV, CostelloD, YonkersKA. Clinical correlates of prescription opioid analgesic use in pregnancy. Matern Child Health J2015;19(3):548–556.
46.
AustinPC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med2009;28(25):3083–3107.
47.
ZouG. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol2004;159(7):702–706.
48.
LadhaKS, NeumanMD, BromsG, et al.Opioid prescribing after surgery in the United States, Canada, and Sweden. JAMA Netw Open2019;2(9):e1910734.
49.
JaniM, GirardN, BatesDW, et al.Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study. PLoS Med2021;18(11):e1003829.
50.
El-TallawySN, AhmedRS, NagiubMS. Pain management in the most vulnerable intellectual disability: A review. Pain Ther2023;12(4):939–961.
51.
MatinBK, WilliamsonHJ, KaryaniAK, et al.Barriers in access to healthcare for women with disabilities: A systematic review in qualitative studies. BMC Womens Health2021;21(1):44.
52.
StillmanMD, AnkamN, MallowM, et al.A survey of internal and family medicine residents: Assessment of disability-specific education and knowledge. Disabil Health J2021;14(2):101011.
53.
CooperS-A, McLeanG, GuthrieB, et al.Multiple physical and mental health comorbidity in adults with intellectual disabilities: Population-based cross-sectional analysis. BMC Fam Pract2015;16(1):110.
HopkinsRE, BuiT, MaglianoD, et al.Prescriber education interventions to optimize opioid prescribing in acute care: A systematic review. Pain Physician2019;22(6):E551–E562.
56.
SirjaniH, Akipinar_ElciM. Impact of educational intervention on knowledge of opioid prescribing among healthcare providers: A systematic review. Virginia Journal of Public Health [Internet]2020;4(3). Available from: https://commons.lib.jmu.edu/vjph/vol4/iss3/4
57.
SetiaM. Methodology series module 3: Cross-sectional studies. Indian J Dermatol2016;61(3):261–264.
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