In The Midst Of An Opioid Crisis, Women Bear A Greater Burden

Photo by Ben White on Unsplash

By Magnolia Potter

The impact of the opioid epidemic across society is undeniable: it has destroyed the lives of the rich, poor, urban, rural, men, women, young, and old. There is no demographic that continues to go untouched by it. However, one group, in particular, may be bearing a greater burden compared to others.

According to the American Medical Association, the opioid epidemic is quickly beginning to look increasingly white and female compared to past statistics. The impact on women and girls has grown most notably in the number of deaths: opioid overdose deaths jumped by 400% among women between 1990 and 2010, which may be the product of doctors prescribing higher dosages per extended period of time.

Unfortunately, there’s little available data that allows the medical community to understand why women are more likely to use and become addicted to prescription opioids compared to men. But it’s not just adult women who are affected. A 2015 NSDUH study showed that just under a million adolescents misused opioids in the past year, and over half of them (518,000) were girls aged 12-17.

Women are bearing a greater burden in the opioid crisis, and it’s one of the many gender-based disparities damaging their physical and mental health. But why is it happening, and what can be done about it?

Women’s Bodies Respond Differently to Opioids

One of the key issues facing women needing help with pain management is that there are currently no prescribing differences between women and men for opioids. And that’s a significant problem because opioid dependency now disproportionately impacts women, which means prescribing opioids comes with a greater risk.

While it is currently unclear why exactly opioids are so destructive for women, it may be because:

  • Women have smaller bodies and thus may develop dependency faster than men.
  • Women are at greater risk for opioid use after the experience of trauma and distress (not found to be a risk factor in men).
  • Women have a link between higher estrogen levels and sensitivity to pain (therefore more likely to report more severe pain).
  • Women are more likely to suffer from poverty (related to higher prevalences of chronic pain and thus dependency)

Although these individual issues are no secret, no steps have been taken to ensure that alternatives to opioids aren’t sought first. 

And these statistics don’t just occur among women using opioids for chronic pain. In a study of ‘opioid-naive’ breast cancer patients (who never took opioids in the past), researchers found that 10% of women who were prescribed opioids to deal with the pain after a mastectomy were still filling prescriptions at three months (and longer) after their surgery. The results found that patients with depression were more likely to continue filling prescriptions with higher doses and patients with anxiety were more likely to refill over longer periods. 

A similar study of endometriosis patients also showed that prolonged use of opioids is more common among women who also used benzodiazepines compared to women who didn’t.

Treating Women Who are Pregnant is Fraught

One of the defining differences for women who become addicted to opioids is that they can get pregnant, and when a woman is pregnant, it dramatically changes the way she interacts with the health system. While women can use opioids as prescribed during pregnancy, the greater rates of misuse and dependency mean that a prescription is a serious risk. There are always risks for both mothers and babies, including poor fetal growth, preterm births, and specific birth defects. However, in some cases, the benefits of using opioids outweigh the potential negative health outcomes.

And there’s significant reason to be worried: a study in Colorado found that the maternal deaths from accidental overdose between 2004 and 2012 outpaced those from suicide. The number is shocking because ill mental health is the most common pregnancy complication

The stress of deciding whether to use opioids or go without is already huge, particularly for women who are very conscious of the potential for dependency. But when you add pregnancy into the mix, the decision becomes even more wrought. Society still treats a pregnant woman not as an autonomous person but as a vehicle for her child’s health: approaching women’s health and opioid dependence this way puts women’s lives at risk.

The stigma pregnant women face is huge. Do you take medication and ideally feel better? Or do you put your pregnancy at risk? The pressure women put on ourselves is huge. Then there’s society: will you face judgment for using prescription opioids while pregnant? The answer is yes because even if no one else knows, you still do.

Pregnancy is one of those issues that demonstrates how making decisions about opioids doesn’t fit into a neat box of medical decision making. Relying solely on biological sciences is not enough to reduce stress. You face judgment if you do, and pain if you don’t. What’s worse: women face stigma and social shame either way.

Can We Help Women Better Navigate Opioid Use?

There is some good news. While social stigma is huge, medical science needed to save women’s lives exists. Drug-assisted stabilization can help women and particularly pregnant women make it through the woods and protect their health (and the health of their unborn children). It’s also covered under Medicaid, which is a hugely important factor in access. In other words, harm reduction is available. The problem is that it’s not always enough.

Above all, health care providers need to further shift pain management practices away from blanket opioid use. The medical system-induced drug crisis has been devastating for all, including and especially women. Both care providers and the general public need to be better aware of other potential pain management options that come without high rates of addiction and overdose. And these plans need to extend far beyond well-funded urban practices and into the heart of the battle: rural and underserved communities for whom pain management has long been opioids or nothing. Doing so will protect opioid access for women for whom opioids are the best option without putting more women at risk of dependency.

The transition away from handing out opioid prescriptions should have occurred a long time ago and it is the least the health system can do. But women deserve more than the bare minimum: they deserve a health system that prioritizes their health, doesn’t see them as vessels for their children and considers all the other bio-psycho-social issues that profoundly impact women. Until then, these health disparities will continue to damage women’s lives.

Magnolia Potter is a muggle from the Pacific Northwest who writes from time to time and covers a variety of topics. When Magnolia’s not writing, you can find her curled up with a good book

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