Table 1.

Standardized Criteria Applied to Accidental Drug-Related Deaths and Suicides

Standardized Criteria for Accidental Drug-Related Deaths and Suicides	Case Examples	No. of Times Identified in Accidental Drug-Related Death	No. of Times Identified in Suicide
1. Pregnancy complication		7	1
a. Increased pain directly attributable to pregnancy or postpartum events leading to self-harm or drug use that is implicated in suicide or accidental death	Back pain, pelvic pain, kidney stones, cesarean incision, or perineal tear pain	0	0
b. Traumatic event in pregnancy or postpartum with a temporal relationship between the event leading to self-harm or increased drug use and subsequent death	Stillbirth, preterm delivery, diagnosis of fetal anomaly, traumatic delivery experience, relationship destabilization due to pregnancy, removal of child(ren) from custody	7	1
c. Pregnancy-related complication likely exacerbated by drug use leading to subsequent death	Placental abruption or preeclampsia in setting of drug use	0	0
2. Chain of events initiated by pregnancy		9	3
a. Cessation or attempted taper of medications for pregnancy-related concerns (neonatal or fetal risk or fear of Child Protective Service involvement) leading to maternal destabilization or drug use and subsequent death	Substance use pharmacotherapy (methadone or buprenorphine), psychiatric medications, pain medications	3	1
b. Inability to access inpatient or outpatient drug or mental health treatment due to pregnancy	Health care professionals uncomfortable with treating pregnant women, facilities not available that accept pregnant women	0	0
c. Perinatal depression, anxiety, or psychosis resulting in maternal destabilization or drug use and subsequent death	Depression diagnosed in pregnancy or postpartum resulting in suicide	1	2
d. Recovery or stabilization of substance use disorder achieved during pregnancy or postpartum with clear statement in records that pregnancy was motivating factor with subsequent relapse and subsequent death	Relapse leading to overdose due to decreased tolerance or polysubstance use	5	0
3. Aggravation of underlying condition by pregnancy		1	5
a. Worsening of underlying depression, anxiety, or other psychiatric condition in pregnancy or the postpartum period with documentation that mental illness led to drug use or self-harm and subsequent death	Pre-existing depression exacerbated in the postpartum period leading to suicide	1	5
b. Exacerbation, undertreatment, or delayed treatment of pre-existing condition in pregnancy or postpartum leading to use of prescribed or illicit drugs resulting in death, or suicide	Undertreatment of chronic pain leading to misuse of medications or use of illicit drugs, resulting in death	0	0
c. Medical conditions secondary to drug use in setting of pregnancy or postpartum that may be attributable to pregnancy-related physiology and increased risk of complications leading to death	Stroke or cardiovascular arrest due to stimulant use	0	0

Boldface indicates totals for each category.