Upsurge in Female Opioid Addiction Tied to Prescribed Pain Meds

Megan Brooks

November 19, 2015

Opioid pain medications prescribed by physicians are the starting point of opioid addiction for the majority of women who become addicted, new research suggests.

"There is an upsurge in the number of women with opioid addiction compared to what is known in the literature, which saw opioid addiction as primarily a men's problem. The current opioid addiction is mainly prescription drugs and much less heroin," study investigator Zena Samaan, MBChB, PhD, MRCPsych (UK), associate professor, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada, told Medscape Medical News.

"A rising number of women are seeking treatment for opioid addiction in Canada and other countries, yet, in many cases, treatment is still geared towards a patient profile that is decades out of date ― predominantly young men injecting heroin, and with few family or employment responsibilities," study author Monica Bawor, PhD, added in a news release.

"Most methadone treatment is based on studies with few or no women at all. We found men and women who are addicted to opioids have very different demographics and health needs, and we need to better reflect this in the treatment options that are available," Dr Bawor noted.

The study was published online November 9 in Biology of Sex Differences.

Dynamic Changes

The researchers evaluated sex differences in substance use, health, and social functioning among 266 men and 226 women receiving methadone treatment for opioid use disorder in Ontario. For the overall sample, the mean age was 38 years, and fewer than half were employed (36%), married (32%), or had finished high school (28%).

Overall, the patients first started to use opioids regularly at about age 25 years and entered methadone treatment at about age 32 years. More than half (52%) of women and a third (38%) of men reported physician-prescribed opioids as their first contact with the drugs.

Compared with men, women had greater physical and psychological burden, reflected by significantly greater scores on the Maudsley Addiction Profile health domains: 17.4 vs 14.5 for physical health (P < .001) and 14.7 vs 12.0 for psychological health (P = .007).

Compared with men, women were significantly more likely to report a family history of psychiatric illness (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.53 - 3.62; P < .001) and to be taking a benzodiazepine (44% vs 36%; OR, 1.60; 95% CI, 1.10 - 2.33; P = .055). Women were also far less likely to be employed and far more likely to have child care responsibilities.

"We have uncovered clinically relevant sex differences that can be used to advance our understanding of addiction and promote strategies for effective treatment and management of opioid use disorder among men and women," the authors note. "The results of this study confirm that trends in illicit opioid use in Canada are undergoing dynamic changes, giving rise to a new sociodemographic profile of opioid users," the authors write.

For example, they note that, compared with findings from studies in the 1990s, the average age of patients being treated for opioid addiction is older (38 vs 25 years), with opioid use starting at a later age (25 vs 21 years). Injecting drug use has dropped by 60%, and there has been a 50% decline in rates of HIV infection among opioid users as a result.

Fundamental Change Needed

Dr Samaan said it is unclear why women are disproportionately affected by opioid dependence originating from prescription painkillers.

"It may be that they are prescribed painkillers more often because of a lower pain threshold or because they are more likely to seek medical care than men," she noted in the news release. "For whatever reason, this is a growing problem in Canada and in other countries, such as the US, and addiction treatment programs need to adapt to the changing profile of opioid addiction."

"The majority of methadone clinics in Ontario are not equipped with specific counseling services (ie, for drug use or for those women experiencing intimate partner violence), social support groups, vocational assistance, or adequate monitoring and treatment of comorbid psychiatric disorders, not to mention specialized management of pregnant women with opioid addiction. These particular issues, which we have highlighted in this study, need to be included as part of a holistic treatment strategy," said Dr Bawer.

"The need for these changes has been acknowledged through the development of programs such as WomanKind (Hamilton, Ontario) or the Sheway Project (Vancouver, British Columbia); however, they have not yet been implemented across addiction treatment centers on a large scale. We do believe this study will shed light on some of these important issues that should be considered in the treatment of both men and women with opioid addiction," she added.

Improving Treatment Outcomes

Commenting on the findings for Medscape Medical News, Amanda Divin, PhD, assistant professor, Department of Health Sciences, Western Illinois University, in Macomb, who was not involved in the study, supports the authors' suggestion to include fundamental services, such as vocational counseling, child care, and parenting assistance, to improve treatment outcomes for women.

"These are fantastic for consideration in treatment programs for women," she said.

"In fact, depending on the motive for initiation and/or continued use, inclusion of vocational counseling, child care, and parenting assistance in communities and prevention programs may go a long way in significantly decreasing the burden of opioid addiction on the woman, her children, her family, and her community," Dr Divin said.

She also highlighted a key difference between Canada and the United States in terms of heroin use. Although this study suggests that heroin use is decreasing in Canada as a result of greater dependence on prescription opioids among women, "the opposite has happened in the US," Dr Divin said.

"In fact, one of the things we've been seeing in the US is that while many individuals initiate opioid use with prescription painkillers, continued use is being replaced by heroin. The transition from prescription opioids to heroin is due to a variety of factors, most notably the increased availability and lower cost of heroin, the reformulation of Oxycontin in 2010 to an 'abuse-deterrent formula,' and the increased difficulty of acquiring prescription opioids because of the 'rescheduling' of hydrocodone by the DEA [Drug Enforcement Agency] in fall 2014," she added.

The Canadian Institutes for Health Research provided funding for the study. The authors report no relevant financial relationships.

Biol Sex Differ. Published online November 9, 2015. Full text

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