Opioid Misuse & Women

The opioid crisis continues to escalate across the U.S., with the number of women who misuse opioids, including those who are pregnant, continuing to rise to epic proportions.

In 2015, drug overdoses for both men and women resulted in 52.404 deaths, according to the Centers for Disease Control and Prevention (CDC). More than 63.1% — or 33,091 deaths – involved opioids. Just two years later, opioid-related deaths climbed to 47,600, or 67.8% of all drug overdose deaths in both men and women.

Increasing Opioid Misuse Awareness

August 20 is designated as Opioid Misuse Prevention Day, a day to raise awareness of the growing opioid crisis and increasing misuse.

Your local Capital Women’s Care team wants to empower you with valuable information, knowledge and awareness concerning opioid misuse as it relates to women, the signs of opioid misuse, understanding the harmful health effects it has on women, those who are pregnant and unborn babies plus realize the destructive consequences opioid misuse inflicts upon families.

Sobering Numbers: Women & Opioids

What’s more, statistics show women’s opioid use continues to rise, with the number of women misusing, abusing and dying from opioid overdoses increasing at alarming rates:

From 1999 to 2016, deaths from prescription opioid overdoses increased 596% for women and 312% for men.

Women age 40-59 are prescribed more opioids than any other age group, receiving twice as many opioid prescriptions as their male counterparts.

This group of women has been proven to have the highest death rates from opioids.

A woman goes to the emergency room for prescription painkiller misuse or abuse every 3 minutes.
The number of pregnant women with opioid use disorder (OUD) at labor and delivery more than quadrupled from 1999 to 2014.

Women age 40-59 age bracket are particularly vulnerable when prescribed opioids post-surgery, with 13% becoming newly persistent opioid users who continue using 3-6 months post-surgery, placing them at an increased high risk for opioid dependence and subsequent addiction.

Women dying from opioid pain relievers increased 5 times between 1999 and 2010.

Between 2005 and 2014, hospitalizations related to opioid pain relievers increased 75% in females over 55% in males.

Types of Opioids

Most opioids are prescribed for acute and chronic pain. Some of the most commonly prescribed opioids include:

Hydrocodone
Fentanyl
Codeine
Oxycodone
Methadone
Morphine

It’s important to discuss pain condition in a forthright, honest manner with your doctor, alert them to all current medications (including non-prescription over-the-counter medications, vitamins, herbs and others), all previously diagnosed physical and mental health conditions and gain thorough understanding and knowledge of the risk factors associated with opioid medications.

Opioid Misuse Factors in Women

Several factors increase women’s overall opioid misuse risk:

Women have more susceptibility and sensitivity to pain than men, perhaps because of the biological and hormonal influences associated with menstruation, fertility, pregnancy, childbirth and breastfeeding.

The CDC reports women are more likely to live with chronic pain and as a result, they may use prescription opioids in higher dosages for longer periods of time.

Women may be more susceptible to craving and relapse behaviors, key factors of the addiction cycle.

What’s more, studies indicate that women are more likely to develop dependency and addiction from smaller amounts of opioids in a shorter timeframe than men, a gender-specific behavior known as telescoping.

Negative early childhood trauma like abuse, neglect, parental violence or having a member of the household experiencing mental illness, substance misuse/addiction, or incarceration correlates directly to women experiencing chronic pain later during their adult years.

Children exposed to the above risk factors also face higher risks of mental conditions and substances abuse as they age, potentially continuing a destructive, harmful cycle.

Women are subjected to greater instances of adult trauma, including domestic violence/abuse, sexual abuse, gender violence, and physical abuse in addition to facing issues which influence opioid misuse like a partner’s opioid use/misuse/addiction/overdose, divorce, losing custody of a child, or experiencing the death of a partner.
Women are also more likely than men to have co-occurring mental/behavioral and substance use disorders. For women, anxiety disorders and major depression have been associated with substance use disorders and are typically the most common co-occurring diagnoses.

In addition to depression and anxiety, studies have identified Post-Traumatic Stress Disorder (PTSD), eating disorders, and agoraphobia with or without panic attacks as co-occurring mental disorders women face coupled with substance abuse.

With combined diagnosed physical and mental health conditions, women often take more prescribed medications, resulting in an increased opioid misuse risk. A 2017 study found women entering substance use treatment programs usually arrive with a range of complex behavioral, medical, psychological, and social issues that are often more intricate than the opioid use disorder that initiated action to seek treatment.

Research suggests women may also be more likely to use prescription opioids to self-medicate themselves for other problems, including non-medically diagnosed anxiety or stress. Sharing prescription and illicit opioids is a burgeoning issue within the already growing spread of opioid use.

The gender role as caregiver may contribute to the amount of stress, anxiety and depression of women, as well as causing them to avoid misuse/addiction treatment due to fear of losing custody of their children or continue caring for family members who are dependent upon them.

Women experience greater sensitivity to some drugs’ effects over men, particularly in relation to nicotine and alcohol use. These proven findings are being examined by researchers further to see if opioid and other substance misuse/abuse/addiction follows similar usage patterns in women.

Is It Opioid Misuse?

It’s important to note that opioid use can become misuse and addiction in very short order, sometimes even within just a few days of taking an initial dose.

If you, a loved one, or friend can answer “yes” to any of the following, it signifies potential opioid use disorder that should be immediately addressed with a healthcare professional:

Have you/they taken opioids for longer than intended or in larger amounts than intended?
Do you/they crave or have a strong drive to use opioids?
Do you/they spend a good amount of time and effort to get and use opioids?
Have you/they missed work, given up spending time with friends and family or doing enjoyable activities to use opioids?
Do you/they give up important social, recreational or work-related activities to get and use opioids?
Have you/they been in situations that are hazardous to your/their emotional health or physical safety to get opioids?
Are opioids having a negative effect on your/their life? If so, are you/they still using?
Do you/they want to cut down or stop using opioids but can’t?

Opioid Use Disorder Symptoms & Behaviors

There are many symptoms and behaviors associated with opioid use disorder, including:

Behavioral changes are often the first signs. These include avoiding eye contact, having mood swings, becoming irritable quickly, acting nervous or being unusually excited/euphoric, having abrupt energy level changes and displaying hostility without warning.

Other changes include losing interest in previously enjoyed activities, sudden changes in friend circles, engaging in secretive behaviors including hiding things, becoming isolated, showing a tendency toward stealing and experiencing sudden legal issues.

Opioid use takes a toll on one’s body. Noticeable changes occur in physical appearance, including weight gain or loss. Other physical indications include raspy, slurred voice; slower breathing; and noticeable balance and coordination difficulties while walking.

Additional physical indicators: constipation; dilated, small pupils; decrease in sexual desire/performance; flushed skin; extreme drowsiness; and scarring/needle marks on arms, hands or feet.

Progressive drowsiness, distance and detached behavior to the outside world. Other behaviors include detachment toward friends and family; lacking awareness of surroundings; and inattentiveness and/or lack of interest toward previously enjoyed hobbies/activities.

Sleep and personality changes often appear: often nodding off or falling asleep, drifting in and out of consciousness no matter what time of day, taking more naps than usual, displaying different personality traits and having difficulty with decision-making.

Memory, relationship and obligation issues. Appears confused, disoriented and has difficulty concentrating which interferes with relationships and aspects of daily life. Shows slow response to questions, avoids problem-solving and ignores obligations. Work or school performance falters, resulting in job problems or lowered school grades.

Relationships further crumble because opioid use is prioritized over maintaining relationships with friends and family. Issues remembering appointments, being attentive to loved ones and missing gatherings or skipping plans with no notice. Daily chores, calling family, taking care of personal hygiene/appearance become neglected.

Initiation of “doctor shopping” or moving on to heroin use. “Doctor shopping” refers to patients obtaining opioid prescriptions from multiple healthcare providers, without prescribers knowing the patient has additional prescriptions. Patients may say they “lost” a prescription and need another filled or complain about increased pain intensity to obtain a stronger prescription.

When prescription drugs become too difficult to obtain, they turn to more available opioids, like heroin. Heroin works similarly to most prescription opioids, fulfills urges and cravings and is more powerful when injected. Many heroin addictions are a direct result of initial prescription opioid abuse.

Having odd items or drug paraphernalia. Opioids may be abused in different ways. Opioids may be taken orally, snorted, smoked and injected. Certain items like piles of burned tinfoil, medication bottles with labels ripped off, tiny pieces of balloons or bloodied cotton swabs are often found in users’ homes and trash.

Other odd items relating to opioid abuse include hose clamps, syringes or needles; bent spoons; rolled-up dollar bills; and straws or tubes cut into smaller pieces.

Experiencing withdrawal symptoms after stopping use (dope sickness.) Withdrawal symptoms occur after a physical or psychological dependence develops when a person is on opioids. This is referred to as “dope sick,” characterized by intense, unbearably painful flu-like symptoms. These symptoms can occur within just a few hours after the drug wears off.

A person may complain of feeling sick during the week. Calling in sick to work or school consistently every week may suggest engagement in heavy opioid use on weekends and subsequently experiencing withdrawal throughout the week.

Opioid Use & Pregnancy

Unfortunately, the number of women with signs of opioid use disorder during labor and delivery more than quadrupled between 1999 and 2014. Opioid use disorder during pregnancy can result in:

maternal death
pre-term delivery
stillbirth

Neonatal Abstinence Syndrome (NAS) or Neonatal Opioid Withdrawal Syndrome (NOWS) – occurs when a pregnant woman uses opioids and her newborn baby experiences opioid withdrawal symptoms.

In 2014, 32,000 babies born in the U.S. experienced NAS/NOWS, a more than five-fold increase since 2004.

Symptoms of NAS and NOWS in a newborn can develop immediately or occur up to 14 days after birth.

Some symptoms include:

¬ß blotchy skin coloring

¬ß diarrhea

¬ß excessive or high-pitched crying

¬ß fever

¬ß increased heart rate

¬ß irritability

¬ß poor feeding

¬ß rapid breathing

¬ß seizures

¬ß sleep problems

¬ß slow weight gain

¬ß trembling

¬ß vomiting

Also, substance use by a pregnant mother can lead to long-term and even fatal effects, including:

¬ß birth defects

¬ß low birth weight

¬ß premature birth

Opioid Use Disorder Treatment During Pregnancy

Buprenorphine and methadone have both been shown to be safe, effective treatments for opioid use disorder during pregnancy. While NAS may still occur in babies whose mothers received these medications, it is less severe than absence of treatment.

Research does not support reducing medication dose to prevent NAS, as it may lead to increased illicit drug use, resulting in greater risk to the fetus.

The American College of Obstetricians and Gynecologists (ACOG) and the American Society of Addiction Medicine (ASAM) support methadone and buprenorphine treatment as best practice for opioid use disorder during pregnancy.

Recognizing Opioid Overdose

Taking too much opioid medication or combining it with alcohol and other drugs can lead to overdose. Since opioids affect the part of the brain that regulates breathing, an overdose can be lethal, often leading to respiratory depression and death.

The 3 signs of opioid overdose, known as the “opioid overdose triad,” include:

pinpoint pupils
unconsciousness
respiratory depression

Opioid Overdose Emergency Response

Death following opioid overdose is preventable basic life support and timely administration of the opioid antagonist naloxone is done. Naloxone, an antidote to opioid overdose, completely reverses opioid overdose effects if administered in time.

Naloxone is effective when delivered intravenously, intramuscularly, subcutaneously, and intranasally, the most popular way to administer the antidote. Naloxone has virtually no effect in people who have not taken opioids.

Since most opioid overdoses are witnessed by a friend or family member, they may be able to reverse the effects of opioid overdose with naloxone while awaiting medical care.

While naloxone is a potentially life-saving emergency interim response to opioid overdose, it is not a replacement for comprehensive medical care.

In recent years, many global programs have shown providing naloxone to people likely to witness an opioid overdose, in combination with training on naloxone use and resuscitation of people experiencing an opioid overdose, could substantially reduce opioid overdose deaths.

A recent U.S. survey found distribution of approximately 50,000 naloxone kits through local opioid overdose prevention programs resulted in more than 10,000 uses to reverse opioid overdoses.

Opioid Addiction Treatment

If you relate to any signs of opioid addiction or notice any signs occurring in a loved one or family member, it’s critical to seek help.

Without help, quitting is extremely difficult. Fortunately, opioid use disorder/abuse/addiction are all treatable diseases.

Treatment usually consists of a medically supervised detox program, followed by combining medications and behavioral therapy.

There are several ways to treat opioid addiction:

Medically supervised detox programs ensure a person’s safety and sobriety during uncomfortable withdrawal processes. These programs typically occur in a hospital or licensed inpatient treatment center and allow specially trained professional staff to administer medications to alleviate symptoms, provide support and prepare patients for additional treatment.

Medication-assisted treatment usesapproved medications to treat opioid addiction/dependence. There are 3 U.S. government-approved medications: methadone, buprenorphine (Suboxone) and naltrexone (Vivitrol). These medications effectively lessen dependence, reduce drug cravings, alleviate uncomfortable symptoms and motivate patient participation in therapy.
Behavioral therapy is the most common type of addiction treatment. It works to modify behavior away from patients’ destructive patterns and thoughts concerning drugs. Two common therapies that successfully treat opioid addiction include Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT.) Both therapies involve the development of coping skills and healthy habits for long-lasting recovery.

Opioids (and Other Medication) Storage

It’s important that all prescriptions and medication are under lock and key and completely inaccessible to children and teens within your home. The numbers of children and teens with access to opioids and other medications in the home have increased experimentation with these drugs at earlier ages due to their easy accessibility.

Additionally, prescriptions should not be shared with other family members or friends under any given circumstance – doing so is against the law.

Safely dispose of unused prescription opioids (and other medications): Find your community drug take-back program, pharmacy mail-back program or follow guidance from the Food and Drug Administration at www.fda.gov/Drugs/ResourcesForYou

If you, a friend or someone within your family is believed to be struggling with opioid use disorder/misuse/addiction or you have questions or concerns about your personal health plan, your local Capital Women’s Care team is here to optimize the quality of your health and well-being, as well as that of your family.

Additional Information

Visit www.cdc.gov/drugoverdose to learn about the risks of opioid abuse and overdose.

The Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline is available 24/7 365 days/year at 1-800-662-HELP. Or visit their website at https://www.samhsa.gov/find-help/national-helpline

Sources:

https://www.healthline.com/health/women-opioids-unseen-impact#3

https://search.womenshealth.gov/search?utf8=%E2%9C%93&affiliate=womenshealth&query=opiod+misuse

https://www.cdc.gov/grand-rounds/pp/2017/20170117-opioid-overdose.html

https://www.cdc.gov/mmwr/volumes/68/wr/mm6836a1.htm?s_cid=mm6836a1_

https://www.womenshealth.gov/blog/news-opioids-women

www.amaalliance.org

https://amaalliance.org/wp-content/uploads/2019/12/AMAA-PTA-Slides-with-notes-11-23-19.pdf

https://americanaddictioncenters.org/opiates/the-effects-of-opioid-abuse-on-women

https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use

https://www.drugabuse.gov/publications/drugfacts/substance-use-in-women

https://pediatrics.aappublications.org/content/135/5/842.long