Tuesday, July 2, 2019

Guest Post - The Opioid Epidemic: Why Are Women More at Risk?


Kate Harveston is a political writer from Pennsylvania. Her favorite topics are feminist-focused, but she writes on a wide variety of social and cultural issues. If you enjoy her work, you can follow her on Twitter or visit her blog, Only Slightly Biased.

The opioid epidemic continues to claim lives across the U.S. Over 47,00 people died of an overdose involving opioids in 2017, a number representing more than half of the total 70,000 overdose deaths in that year, and data from 2018 has yet to confirm or deny improvement in this statistic. Other see their lives torn apart by addiction, suffering job losses and difficulties in interpersonal relationships.
Sadly, many of those affected by the epidemic are women. Multiple reasons exist for why women fall prey to opioid addiction at higher rates than men, from biological differences to societal pressures. What researchers know about how the opioid epidemic impacts women more harshly may help others.
Biological Differences in Addictive Tendencies
[Blog note: The following uses cisnormative language due to the fact that the current science still engages in the idea of biological sex and treats everyone as cis. We acknowledge that trans and non-binary people exist even if much of the scientific community still fails to do so.]
One reason cis women fall prey to opioid addiction more frequently has to do with basic biology. A factor impacting why women become addicted more often is due to the fact they suffer from chronic pain conditions more often than men do.
In one study spanning 17 countries and consisting of 85,000 participants found the occurrence of chronic pain is more prevalent in women than men. Women tend to suffer from musculoskeletal conditions such as arthritis and low back pain more often. Additionally, they suffer from stomach disorders and headaches more often than men do as well.
Furthermore, cis women tend to have more body fat than cis men in general, which impacts how medication is absorbed and concentrated in the body. Drugs can either be water or fat soluble or a combination. Drugs which are lipid soluble tend to build up in the fatty tissues whereas water-soluble drugs remain in the bloodstream.
Fentanyl, a powerful opioid several thousand times more potent than morphine, is fat soluble. While research has yet to confirm this definitively, one possible reason cis women fall victim to opioid addiction more often could be the way the drug builds up in their fat tissue, leading to fatal overdoses.
Another biological reason for the differences in opioid addiction rates between men and women has to do with hormones. In particular, researchers have implicated estrogen in increasing the chances of developing an addiction.
Research at the Icann School of Medicine at Mount Sinai indicated estrogen intensifies the effect of dopamine on the brain. Dopamine is a feel-good chemical involved in the brains' reward center. During certain parts of her cycle, a cis woman becomes more receptive to perceived rewards, which, in the case of addiction, results in getting more of a positive "rush" from taking certain drugs.
Different Societal Pressures Women Face
In addition to having stronger innate biological tendencies toward addiction, women face different societal pressures than their male peers, which can further influence their tendency to escape through substance use. For example, women tend to use meth at rates three times higher than men, most likely due to the way society expects women to maintain unrealistically low body weight to meet conventional standards of attractiveness.
Indeed, a disturbing recent study showed that when it comes to what society values most in women, physical attractiveness tops the list, followed only by empathy and nurturing ability. Compare this with men, in whom honesty is valued most, followed by professional accomplishments. Attractiveness falls way down in sixth place on the list for the XY chromosomal set.
In a society where few families can keep up with the cost of living without two incomes, women have to do double duty. Not only do they need to venture into the workforce and grind hard all day, they often feel they must do so while keeping their hair perfectly coiffed, their bodies sculpted to a T and their skin smooth as a newborns'. 
And they have to do it all while nurturing everyone else's needs before their own — is it any wonder they feel the need to escape into addiction more than men do?
Alternatives to Opioid-Based Pain Management
Addressing the rates of opioid addiction in women by simply cutting patients off their medication is cruel and can prove dangerous. Even though many women may find they can manage pain through alternative means, some such treatments are not currently covered by insurance.
Medical cannabis may offer one route out of opioid addiction while still providing pain relief. Although research to date shows similar rates of relief when comparing cannabis to opioids, a far more vast body of knowledge exists about opiates. 
Cannabis' Schedule I classification under federal law has hindered research. Plus, even in states where recreational and/or medical cannabis are legal, most disallow coverage of the substance by health insurers, meaning patients must pay out of pocket. Although prices for cannabis prove less costly than many prescription medications, lack of coverage still places an undue burden on the poorest women.
Alternative pain therapies such as acupuncture, chiropractic care and even training in how to eat an anti-inflammatory diet can help patients achieve pain relief naturally. However, although some insurers now cover chiropractic, relatively few cover alternative therapies such as acupuncture and Ayurvedic treatments. Elite women can afford these therapies, but the poor once again get left behind.
What will truly help end this problem is a huge societal shift in how we view women, the poor and the drug-addicted populations in our country.
Helping Women Find Relief
Those who fear a woman they love may suffer from opioid addiction do well to reach out in a loving manner and offer help. Both inpatient and outpatient therapy exists to help women tackle addiction. Even those lacking insurance can take advantage of support groups such as Narcotics Anonymous for help.
In the end, expanding access to alternative treatments and considering biological and societal differences prior to prescribing opioids will help cut addiction rates. While few doctors want those patients who need opioids for any quality of life to suffer unnecessarily, exploring alternative options prior to proceeding to such treatment regimens will reduce addiction rates.
Finally, as a society, we must offer more support and love for women in need. We need to stop pressuring women to do it all, and instead value them for the unique talents they possess. A little more compassion will go a long way in preventing and treating addiction in both men and women alike.

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