Opioid use has reached epidemic proportions in the United States, posing new challenges for first responders, community service organizations, and healthcare professionals, among others. The use of overdose reversal drugs like Narcan has skyrocketed. Stronger, synthetic opioids can cause spates of overdoses in rapid succession. But while many on the front lines of the addiction epidemic are focused primarily on urgent interventions, little attention has been paid to the sex-based differences in opioid use. Gender plays a major role in how addiction manifests.
Doctor Shopping and Prescription Risks
One reason that opioid addiction has the potential to be deadlier in women than in men is that, according to the CDC, women are more likely to have simultaneous prescriptions for an opioid painkiller and a benzodiazepine, a common class of drug used to treat anxiety. Benzodiazepines, widely known by brand names like Xanax and Ativan, also have a high risk of abuse and are considered controlled substances, but are generally less heavily restricted than opioids.
Doctors, of course, know the dangers of simultaneously prescribing opioids and benzodiazepines, but many get around that through the common practice of “doctor shopping” – going to different practitioners to get prescriptions for restricted medications without divulging one’s medical history or what other medications one is on.
Julie Worley, a professor of nursing at Rush University, has been working to reveal what it looks like when women go doctor shopping. She hopes to reduce this behavior and help clinicians spot doctor shopping in their own practices. It’s a long road and one that requires empathy for the women engaging in such behaviors, but identifying doctor shopping in action can be one of the most valuable interventions a prescriber can make to help those with substance abuse problems.
Where Pregnancy and Addiction Intersect
Another important factor that complicates opioid addiction and treatment in women is pregnancy. Since the start of the epidemic, U.S. hospitals have seen a rapid increase in infants born with opioids in their systems. This can be extremely dangerous, for both women and their fetuses.
First, women who try to quit opioids unsupervised during pregnancy can suffer serious withdrawal symptoms. Opioid withdrawal symptoms include nausea and vomiting, high blood pressure, and rapid heartbeat, all dangerous no matter the circumstances, and though it’s not always possible, those looking to quit such a drug should do so under the care of a doctor.
Second, women who continue to use opioids throughout the pregnancy, or even continue on a traditional addiction treatment program such as taking suboxone, may give birth to children who suffer, at minimum, withdrawal symptoms of their own at birth. Withdrawal in infants is known as neonatal abstinence syndrome (NAS) and varies in severity among infants depending on size, age, and the severity and length of the mother’s addiction.
Finally, children with NAS may also have other birth defects, increased risk of sudden infant death syndrome (SIDS), and developmental, cognitive, and emotional delays, similar to what was seen in crack cocaine addicted infants in the 1980s and 1990s.
There are no simple solutions to the opioid epidemic, in women or in the general population, but that doesn’t mean there aren’t prominent ideas and valuable services that can contribute to harm-reduction efforts. Among them, increased access to mental health care is one of the most important steps, but also one of the most difficult to implement, due to time and associated costs. Tools like cognitive-behavioral therapy can help quell chronic pain that leads to potential opioid abuse, and can also help change thought and behavior patterns in those already struggling with addiction. The power of the mind is undeniable.
Similarly, better management of chronic pain is also a necessary part of harm prevention. Few people with long-lasting pain receive real help managing it – they’re either handed a prescription, left to suffer, or both in some combination. Teaching patients how to better manage pain flare-ups and taking alternative measures to reduce pain can help individuals avoid addiction in the first place. We will not eliminate addiction overnight, but by identifying specific risk factors for individuals, women, and the population at large and taking appropriate steps to address them, we lay the groundwork for aiding those most affected.