Why women are now bearing the
brunt of the epidemic.

Treatments Must Adapt As The Opioid Crisis Takes On A New Face

A lady began experiencing back pain during her high school years. The ache would not go away, but she was unsure of how or why. Lady was diagnosed with degenerative disc disease when an MRI finally showed that she had a bulging disc. He prescribed her some Percocet.

Once at home, Linda discovered that she felt best when she took many Percocets at once. She would occasionally devour five or six at once.

“I’ve always known that narcotics are bad for me,” the woman declares. She had used marijuana and cigarettes with her mother, who had an addiction to drugs, but nothing more strenuous. “When I took something that my doctor had prescribed, I never even considered the possibility of a risk.” I didn’t believe I would experience anything like that.

Linda didn’t feel the need to consume opioids after the prescription ran out, but she did recall how wonderful it felt. A few years later, she began experimenting with synthetic cathinones, or “bath salts,” and then meth, heroin, and Xanax. Linda fought for years to receive assistance for her problem with opioid consumption. After detox, she would relapse, buy medication, and sign up for different programs.

Her first overdose occurred in 2021 when she snorted a Percocet and curled up in bed with her partner.

“I was blue when he tried to roll me over,” the woman claims.

Her partner began doing CPR while dialing 911. It was unknown at the time that Linda was expecting a child.

Over the past ten years, millions of women have battled opioid use disorder, including Linda. Linda however lived in contrast to the projected 80,411 individuals who perished from an opioid overdose in 2021.

It has been ten years since opiates were widely prescribed and sold by the bottle and six years since the US Department of Health and Human Services proclaimed opioid abuse to be a national pandemic. However the horrifying overdose incidents that characterized the early 2000s continue to occur. In actuality, things are worse for women.

Even while it often receives less coverage and attention than what’s occurring among young men, the opioid pandemic has been progressively becoming worse for women in recent years, and it’s now difficult to ignore. 

 Additionally from 2019 to 2021, the number of women dying from overdoses surged by 40% during the COVID-19 epidemic alone. (Even though women still account for fewer overdose fatalities than men—nearly three to one—women are affected by the epidemic in unique and complicated ways).It is impossible to overestimate the extent to which the current problem has been exacerbated by the pandemic effects on social support networks and the expanding availability of both legal and illicit fentanyl in the United States.

There has been a disproportionate impact on mothers and women of color. A November 2023 research from the National Institutes of Health found that overdose mortality more than quadrupled between 2018 and 2021 among women between the ages of 35 and 44 who are pregnant or recently gave birth. Moreover drug overdose fatalities  for Black women almost quadrupled between 2015 and 2021, Overdoses rank as the fourth most common cause of death among Black women, after cancer, heart disease, and COVID-19.

However, according to Virginia Commonwealth University ob-gyn and addiction medicine specialist Caitlin E. Martin, MD, MPH, over the past ten years, doctors have not prioritized therapy specifically for women. “All we’re doing is getting caught up with what has been happening all along.”

Opioids and women have a long history together.

Doctors started administering morphine, a potent opioid that is currently mostly used for pain relief, minor procedures, and cancer treatment, to “hysterical” mothers in the late 1800s. The medication was used back then to treat pain reproductive issues and what would be considered chronic exhaustion today.

“Dr. Frederick Heman Hubbard said in a book on alcoholism and opiate addiction published in 1881 that more women become addicted to drugs as a result of uterine and ovarian problems than from any other illnesses put together.” Around the turn of the 20th century, women made up about 60% of opiate users.

After the federal government started regulating drugs in 1906, the pandemic decreased but it resurfaced in the 1990s when pharmaceutical firms started aggressively selling opioids like OxyContin for immediate, efficient pain treatment. By 2004, OxyContin was one of the most often abused drugs in the US. 

Additionally, according to Dr. Martin, doctors prescribed more medicines to women because they had higher rates of chronic pain (such as those brought on by endometriosis or fibromyalgia). Indeed, the likelihood of women using abusive prescription medications as males, according to a 2000 Brandeis University study. In 2017, sixty five percent of opioid prescriptions were written to women.

However, the government led initiative known as “the War on Drugs” had already started in an attempt to curtail the illicit drug trade in the United States between the first and the second opioid pandemic. Also, it was especially harsh on mothers and women.

Vice president of government and public relations of the Indiana Center for Recovery and nationally renowned authority on harm reduction and drug policy reform, Chad Sabora, says, “Our country has used drugs to weaponize society against specific communities.That hate was aimed at Black moms and their alleged “crack babies” in the 1980s.

Hospitals started drug testing Black women they suspected of using crack cocaine during their pregnancies as drug usage enforcement increased and they reported positive results to child protective agencies. Congress reverted to that approach in 2016 when it approved a significant financing package to combat the opioid epidemic. The bill obliged doctors to report any suspicions of child abuse, and many states regarded positive drug tests as proof of abuse.

And while Black Americans in metropolitan areas have seen disproportionately high rates of overdose mortality in recent years, the current opioid crisis first struck hardest in white rural communities.

Adrianna “AJ” Kenley began drinking at her high school in Kentucky in an attempt to defuse the discomfort of trying to fit in as a multiracial teenager. She then lost the college sports scholarship she was banking on when she played volleyball during her final year and tore the ACL, MCL and meniscus in one of her knees. AJ claims that after receiving painkillers from her doctor she gave up drinking.

She said that she experienced no feelings at all when taking the prescribed painkillers. It made her social anxiety less severe. When the prescription ran out, she and her pals drove to Florida, where they heard of clinics that provided loose opioid prescriptions, sometimes known as “pill mills.”

AJ spent a few years in prison in her 20s due to drug related offenses. A family friend once sent her a copy of The Big Book, the manual for Alcoholics Anonymous while she was incarcerated. “After I came out, I stayed in touch with that friend and she is still my sponsor now.”

AJ, a nine-year-sober ambassador for Shatterproof, a nonprofit organization that transforms addiction treatment, claims that the pandemic significantly hampered her ability to heal. “My home group completely disbanded,” she claims. Conference calls replaced in-person sessions, and the individuals who had played such a crucial role in her rehabilitation became voices on the other end.

She says,”It just wasn’t the same.”

Hendrée Jones, PhD, addresses substance use disorders in pregnant and parenting women as well as their children. She is a professor of obstetrics and gynecology and a senior advisor for the University of North Carolina Horizons Program. She has seen patients who had been stable and attending Narcotics Anonymous support groups lose those spaces and occasionally their lives.

Psychological safety “was not given near enough attention because physical health and safety were given such a priority,” claims Jones. And where would the ideal environment for a drug use disorder to flourish be ? loneliness, boredom, dread and isolation.

But more factors entered the scene as well, creating a very awful perfect storm. Treatment and harm reduction initiatives like as needle exchanges and Narcan distribution centers, have stopped operating. Mothers in particular had to adjust to raising children who were not in school. When living in an abusive home, women had nowhere to go around. A greater number of persons used drugs alone as a result of social alienation, with no one around to help them if they overdosed. Sheila Vakharia the Drug Policy Alliance’s deputy director of research and academic engagement, notes that at the same time, the majority of the drugs supplied in the United States were created illegally, specifically fentanyl.

According to Jones, “both overall and lethal overdose rates have grown more than I’ve ever seen in my whole career.”

The epidemic revealed everything, especially to women.

Effective therapies exist, but they can be stigmatized and are not always well-known.

Scientists now know that opioid use disorder (OUD) may be treated with medicine and therapy; addiction is not a moral failing but rather a chronic disease that rewires the brain. Dopamine, a neurotransmitter linked to pleasure, is flooded into the brain’s reward system by opioids, inducing a hormonal reaction that can be ten times stronger than one brought on by “natural rewards” (eating your favorite cuisine or spending time with a friend).

Research suggests that although not everyone who uses drugs becomes dependent, there are hereditary and traumatic childhood experiences that can increase an individual’s likelihood of forming a drug dependence.

Understanding the biological mechanisms underlying opioid use disorder and working to eliminate the stigma associated with it have made treatment centers’ programs more effective..

“Medications for opioid use disorder can save lives,” states Dr. Martin. Opioid agonists like buprenorphine and methadone when administered appropriately, can cut the chance of overdose death in half. “Of all the medications I have prescribed this one is the most useful to society.”

Opioid agonists, which bind to the same brain receptors as opioids to avoid withdrawal without making the user feel euphoric, can be taken once daily as a liquid, pill, or a coating that melts in the cheek or beneath the tongue.

Terms like “addict” and “user” are gradually being phased out in favor of phrases like “person with substance use disorder” and “patient,” as scientists and medical professionals gain a deeper understanding of the brain mechanisms behind this chronic medical disease.However that does not imply that everyone has realized this yet.

According to Vakharia,”women face more and different and complicated stigma for their drug use,” and this is particularly true for mothers or expectant mothers. Many women are motivated to conceal their drug usage because of this stigma which thereby increasing their chance of overdosing on their own and staying away from medical facilities where they could receive assistance.It also contributes to the explanation of the threefold increase in overdose deaths among pregnant and postpartum women during the previous five years.

Furthermore not all substance use programs cater to the needs of pregnant or postpartum patients and some medical professionals are not trained to recognize the warning indications of substance use disorders or to assist women in accessing treatment.

Because the options available to her as a new mother didn’t suit her needs Tara Hollingshead struggled to get treatment for her opioid use disorder.

Tara moved into a sober living facility following her 90 day rehabilitation program following the birth of her first daughter in 2018. However, she missed her daughter, and she relapsed after making the decision to go back home. Tara was bedridden when she discovered she was pregnant again in late 2020 due to her severe sickness, which forced her to duct-tape a trashcan to her bed.

Tara found it hard to think that she would have to wait at a drugstore every day to be enrolled in a treatment program, since methadone and buprenorphine are often provided at a clinic. Following the birth of her second daughter, Tara began contacting rehab centers, but there were no beds available.

A few weeks later, Tara was detained while driving home from a doctor’s visit. She was first accused of possessing drugs. She was then accused of another crime by the prosecutor in her birthplace of eastern Ohio: giving a controlled narcotic to a pregnant person, in this case, herself. She received a sentence of at least eight years in jail on May 18, 2022.

Tara, who disputed the accusation and was freed a year later is one of 1,379 persons detained between 2006 and June 2022 for suspected misdemeanors committed while pregnant, ranging from failing to buckle up to failing to receive prenatal care. According to Lourdes A. Rivera, president of the legal advocacy charity Pregnancy Justice, more than 90% of those arrests were linked to claims of substance use during pregnancy, and one-third of those arrests were made in a medical facility.

Women are looking for a way to go forward.

Linda’s father assisted her in enrolling in a University of North Carolina at Chapel Hill drug rehab program that focuses on treating expectant and parenting women a few months after she overdosed a second time. Linda recollects thinking how great it was to have basic items like cleaning materials, aluminum foil, and Ziploc bags when she arrived. Every woman enrolled in the UNC Horizons program received her own apartment allowing her to reside with her newborn. According to Linda, “They provided what felt like complete wraparound care.” She saw an ob gyn, therapist, case manager, primary care physician and psychiatrist in a matter of days.

Days following Linda’s arrival Brandi Collins signed up for the course. After being imprisoned for drug offenses during her pregnancy, Brandi was informed by a peer counselor that she could get treatment while maintaining custody of her child.

“I had no idea that such programs even existed.” “I wish more people were aware of resources like this you can get help with your baby without having to worry about losing them,” Brandi added. If I couldn’t have taken my baby I never would have sought help. Never would I have consented to improve.

The 2020 National Survey of Substance Abuse Treatment treatments found that just 25% of treatment programs in the US provide treatments especially designed for expectant or new mothers.The Midwest and South are particularly difficult places to find these programs.

According to Dr. Martin, it should be standard practice for addiction clinics to provide childcare alongside gynecological and menta services (since women who use opioids are more likely to have co-occurring anxiety, depression, or PTSD, and may also be at a higher risk of suicide). According to her, the “base model” of addiction therapy has been developed over many years for white male patients and “anything that’s specific for women is considered a ‘add-on.'” However Dr. Martin points out that this strategy is incompatible with the factors that led to the drug war and the opioid epidemic, which involved overprescribing to and penalizing women.

“A care system that is not predicated on women’s anxiety of losing their children is necessary,”said Chad Sabora

According to Sabora, “there needs to be a system of care for women that is not based on their fear of losing their children”.Revisions to drug testing and reporting regulations as well as enhanced privacy protections are demanded by Rivera and her colleagues at Pregnancy Justice.

Jones who is in charge of the facility where Linda and Brandi had their treatment, believes there are methods to increase accessibility to opioid agonists, which are drugs that are used to treat opioid use disorder. Methadone is a drug that lessens cravings and withdrawal symptoms; during a pandemic, the federal government relaxed regulations on it enabling patients to take their prescription at home rather than in a special treatment facility.

Addittonally the Substance Abuse and Mental Health Services Administration removed an elaborate registration and training requirement earlier this year, which had prevented physicians from prescribing buprenorphine. These are crucial initial steps, she adds, and she’s interested to watch how laws like the one Washington State is implementing to provide split-doses of methadone—which let patients take the drug twice daily rather than just once—work out. This will help patients who are pregnant by reducing adverse effects.

After living together in a Chapel Hill apartment at first, Brandi and Linda now each have their own place, raise their kids and work as peer support specialists at a community behavioral health clinic.While Linda is completing her associate’s degree, Brandi is getting ready to move into her first apartment.

According to Linda, “there are nowhere near enough” therapy facilities dedicated to helping expectant moms and women. She and Brandi want to contribute to helping those who have been in similar circumstances. “You are fixing a whole family if you take care of the mother and provide her with the resources and support she needs”.

People are beginning to wake up and pay attention even though there is still plenty that medical professionals can do to treat substance use disorders better and legitimize them as mental health illnesses so that the opioid pandemic in women takes a very different turn. Jones declares, “I see change”. “I think it’s exciting that more providers who adopt a more person centered, compassionate care approach are entering the field”.