Women Face Higher Opioid Toll

March 2, 2017

Image of a prescription pad with the text: Every year since 2007 more women have died from drug overdoses than from motor vehicle crashes. The face of the epidemic is fast becoming young, white and female.
The rate of overdose deaths among women has risen in tandem with increasing prescriptions for the past 15 years (see CDC graphic below).

 

The nation's epidemic of narcotics misuse – most recently underscored by a spike in heroin-related deaths – is especially threatening to the health of women and girls, experts with the Centers for Disease Control and Prevention reported in a recent webcast.

Natural and synthetic opioids are increasingly being used by women. These substances range from illegal drugs like heroin, to legally available pain relievers such as oxycodone and Fentanyl, a powerful analgesic similar to morphine but 50 to 100 times more potent.

The face of the epidemic, warned Dr. Mishka Terplan of Virginia Commonwealth University on Jan. 17, is fast becoming "young, white and female."

Not only has heroin use been increasing faster among women than men, it doubled in the decade between 2002 and 2013. This week alone, the Agency For Health Research and Quality reported that opioid-related emergency department visits more than doubled between 2009 and 2014 in three states -- Minnesota, Ohio and South Dakota. And the National Institute on Drug Abuse reported that more than 21,700 infants in 2012 were born in drug withdrawal, a five-fold increase since 2000.

Said Karin Mack of the CDC's National Center for Injury Prevention and Control: "Our mothers, wives, sisters, daughters are dying from these overdoses at rates never seen before."  

Certain biological factors, including smaller body mass and differences in absorption and metabolism rates, "put women at increased risk for dependency and health consequences of use over a shorter period of time," said nurse-practitioner and former Maine state health official Linda Frazier.

"This means that women can have more severe opiate withdrawal and be at a higher risk of opiate overdose," she said.

Dr. Mishka Terplan of Virginia Commonwealth University, Karin Mack of the CDC's National Center for Injury Prevention and Control, and nurse-practitioner and former Maine state health official Linda Frazier.
Dr. Mishka Terplan of Virginia Commonwealth University, Karin Mack of the CDC's National Center for Injury Prevention and Control, and nurse-practitioner and former Maine state health official Linda Frazier.
 

Beyond that, health care professionals are more apt to miss the signs of addiction in women and girls, "who are more likely to receive long-term prescriptions for sedatives and analgesics for depression, anxiety or other disorders," Frazier added.

Several other risk factors make women and girls more vulnerable: Women are more likely than men to live longer, experience pain and be prescribed addictive medications -- and women over 55 are the single largest consumers of the drugs. Moreover, drug use is increasing among girls ages 12 to 17, who misuse psychotherapeutic medications at "significantly higher rates" than their male peers, said Frazier.

In 2015, more than 21 million women had "used an illicit drug or misused a prescription medication in the past year," said Mack of the CDC. And seven out of 10 women who reported using heroin had previously used prescription opioids.

A 2013 CDC report found that a woman goes to the emergency room for an overdose every three minutes – and 31 die every day. Overall, overdose deaths increased 400 percent among women between 1999 and 2010, at a time when prescriptions for the drugs quadrupled.

Health care providers wrote more than a quarter billion opioid prescriptions in 2013, "enough for all 240 million adults in the United States to have a bottle of pills," Mack reported. And yet, according to the Office of the U.S. Surgeon General, there has not been an overall change in the amount of pain that Americans report.

A chart showing the an increase in Prescription Opioid Deaths by women from 1999 - 2015, as compared to opioid sales over the same time period. Data from: https://www.cdc.gov/vitalsigns/painkilleroverdoses/

 

The office issued a letter in August to more than two million clinicians across the country about the epidemic – the first direct outreach to practicing providers in history.

The key to tamping down the misuse of opiates is effectively integrating behavioral health services into primary care, said VCU's Terplan.

"We are not just treating people from the neck down," he said. "It is very important that we seize the moment" to screen and get women into care.

CDC released its Guideline for Prescribing Opioids for Chronic Pain in the spring of 2016, urging clinicians to be much more conservative about who receives the drugs, and for what conditions.

Learn more about what HHS is doing to combat the opioid epidemic.

Last Reviewed: March 2017



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