The United States is in the grip of an opioid epidemic. It has been declared a public health emergency, and the US government is launching a campaign to raise awareness of this issue.
But one thing such campaigns fail to acknowledge is that women bear the greater burden of this epidemic. Due to a variety of factors, they are most at risk of opioid addiction. Read on to discover why, and what alternatives are available to help break this cycle.
By Scott McDougall, MPharm
Physician prescribing behaviors focus on women
Women are more likely to be prescribed opioids by their physician. In fact, women currently comprise 65% of total opioid prescriptions in the US, compared to just 35% of men.
Such a disparity between the genders is difficult to attribute with accuracy, although it may be due to the statistically higher occurrences of chronic pain and diseases in women than men. A report by the QuintilesIMS Institute found that women aged 40-59—the age that such conditions tend to manifest—are prescribed opioids more than women in any other age range. This group also has the highest death rates from opioid use too.
Further to this, 40% more women become frequent opioid users following surgery than men.
Biological differences create a fight against genetics
Much of the burden on women is likely due to differences in how each gender experiences chronic pain. Evidence shows that women are more likely to experience chronic pain than men. But why is this?
Studies show that the answer lies in the biological differences between the two sexes. Childbirth, fertility issues, reproductive cancers, and other defining characteristics that are unique to people with female reproductive capabilities place them at higher risk of opioid dependence.
For example, hysterectomies, caesareans, mastectomies, and other surgeries specific to female reproductive organs contribute to women’s overall greater likelihood of undergoing major operations. Consequently, they are more likely to be prescribed—and use—prescription opiates to treat the pain.
The effects of drugs on female users are also vastly different than on male users. For starters, women may be biologically predisposed to develop dependencies on prescription pain medicines.
Sexual violence can foster addiction and dependence
In addition to biological factors, sexual violence, trauma, depression, and anxiety can play a huge role in determining why women are more likely to suffer from opioid abuse.
Women are 2-3 times more likely to experience post-traumatic stress disorder (PTSD) than men. This is due to a number of reasons, but foremost among them (and most troublingly) is their increased likelihood of experiencing sexual assault or child sexual abuse.
For many women suffering from PTSD (diagnosed or otherwise), opioids don’t just help them cope with the pain—it also helps them deal with anxiety resulting from trauma.
Other factors include existing mental health issues such as depression or an anxiety disorder and a history of addiction (both for the individual and her family).
What alternatives to opioids are available?
The evidence above paints a bleak picture, and many women will require some form of pain medication at some point in their life.
Thankfully, there are a number of alternatives to pain medication that are effective in treating and managing chronic pain issues.
Non-opioid painkiller medication
As well as opioids, there are other forms of pain medication that are proven to be effective in helping patients cope with pain.
Acetaminophen (often sold under the brand name Tylenol) is a commonly-prescribed painkiller which has little risk of dependency or abuse. It’s readily available over-the-counter at most pharmacies and has many fewer side effects.
More potent medications include nonsteroidal anti-inflammatory drugs (NSAIDs). These are over-the-counter drugs such as naproxen and aspirin, and again carry a low risk of dependency. However, side effects from these can be more severe and there is a risk that they might interact with other medications.
While cannabis has been used as a medicine for thousands of years, it has recently been thrust to the fore following the relaxation of marijuana laws.
Medical marijuana has been shown to reduce the perception of pain in clinical trials. And while this is powerful evidence for cannabis as a pain relief medication, it also has a knock-on effect for opioid prescriptions. That is, those states that have legalized marijuana report a reduced number of opioid prescriptions than those states that restrict its sale.
The value of exercise is something oft emphasized but rarely appreciated. As well as being effective at combating mental health issues such as depression or anxiety, it also helps manage and reduce pain too.
Runners are often told to run an injury off, and with good reason. In many (but not all) cases, gentle exercise helps your body cope with pain, pushing yourself past it. Of course, this should only be done in moderation. Excessive exercise will hinder, rather than help, with any pain management issue.
The opioid epidemic is a public health issue that needs rapid, concerted action—especially for women. Alternatives can reduce their risk of abuse while helping them treat their issue.
Scott McDougall (MPharm) is the co-founder and registered manager of The Independent Pharmacy, one of the UK’s leading independent online pharmacies. For more health care and treatment advice, visit their website.