It’s been 2 years since the Department of Health and Human Services (HHS) declared a state of emergency to address the opioid crisis. And while awareness is greater, the United States and Canada are still in the midst of one of the worst drug crises seen to date.

With a continued reliance on prescriptions for powerful opioids such as fentanyl and a booming black market, there’s a growing need for action on a national level to address the opioid epidemic.

Taking on and helping solve the opioid crisis isn’t a simple equation. It involves determining the underlying causes of opioid addiction, developing effective treatment plans, and supporting ongoing research to improve interventions.

But solutions also need to address one of the biggest problems: the lack of a gender-based approach to determining the differences (and treatments) for women with an opioid use disorder (OUD).

Research has found the use of opioids as a medical treatment for pain is one of the more common pathways to OUD for women in comparison to men. One of the underlying reasons for this is that women have reported more sensitivity to painful stimuli and therefore have a higher risk for pain.

There are many reasons women use pain-relief medications, ranging from hormonal issues and menstrual cycle pain to menopause, pregnancy, breastfeeding, and fertility. But as OUD has grown to epidemic proportions, opioids have also been used, often to self-medicate, for everything from weight control and exhaustion to mental health issues.

“The opioid use disorder crisis affects women across all age groups, all racial groups, all ethnicities, all geographic quarters of America and all socioeconomic status levels.”
— Brian LeClair, HRSA principal deputy administrator

According to independent research carried out by the QuintilesIMS Institute in 2016 and 2017:

“Women ages 40–59 are prescribed more opioids than any other age group and receive twice as many opioid prescriptions as their male counterparts. This population is also particularly vulnerable when prescribed opioids after surgery, with about 13 percent of middle age women becoming newly persistent opioid users who continue to use opioids 3 to 6 months after surgery, which puts them at high risk for dependence and addiction. Among women, this age group has been shown to have the highest death rates from opioids.”

Just as women experience pain more acutely than men, they’re also more likely to receive a prescription for an opioid pain reliever for chronic conditions, such as migraine. To further compound the problem, women are more likely to receive a prescription for additional medications that can increase the risk of overdose.

The Centers for Disease Control and Prevention reports that women are more likely to live with chronic pain. As a result, they may utilize prescription opioids in higher doses for longer periods of time.

Some of the most commonly prescribed opioids include hydrocodone, fentanyl, codeine, oxycodone, methadone, and morphine.

Benzodiazepines are commonly co-prescribed more frequently for women than men. However, despite the significantly higher level of prescription opioids for women, there are more opioid use disorder deaths among men.

“There is emerging knowledge about the many factors that affect a woman’s path to opioid misuse and opioid use disorder, including biological and social influences, past experiences, geography, and demographic characteristics, but more needs to be learned about each aspect of this path.” — Office on Women’s Health

The National Institute on Drug Abuse (NIDA) reports that women are:

  • more likely to develop dependency and addiction from smaller amounts of substances in a shorter period of time
  • more likely to be sensitive to the effects of certain drugs than men
  • more likely to go to the emergency room or die from an overdose

Issues NIDA notes that lead women to misuse substances include:

  • experiencing domestic violence
  • divorce
  • losing child custody
  • death of a child or partner

A 2017 HHS study found that women who enter a substance use treatment program generally arrive with a range of behavioral, medical, psychological, and social issues. These issues tend to be more complex than the OUD that brought them to treatment.

Given that OUD seems to be more common and severe in women, it only stands to reason that treatments should be gender-specific.

There are certain substance use treatments known to work better in men, such as the use of disulfiram in the treatment of cocaine addiction. At the same time, other treatments — such as the use of naltrexone for alcohol use disorder — work well for both men and women.

To date, research has found the use of buprenorphine — one of the most effective treatments for OUD — works at least as well for women as it does for men.

However, healthcare has historically avoided gender-based treatments. One could argue that this, in part, has contributed to the increased level of OUD in women. Treatment plans for women need to incorporate things such as:

  • child care
  • screening for psychological issues, such as anxiety and depression
  • relationship counseling

Treatment should also look at finding ways to protect women who have children or who are pregnant from losing custody should they choose to enter an inpatient treatment program.

Today, there are vast opportunities to learn more about gender-based treatment for OUD than at any other time in history. Researchers need to conduct more studies on:

  • how pain levels differ in women and men
  • the best ways to tailor counseling
  • the types of medication used in treatment
  • how controlled substances such as opioids affect women’s neurobiological pathways in the brain

To overcome the unique and significant issues OUD presents in women, we must continue to fund gender-based studies and commit to the research and resources necessary to ensure that women are getting the effective treatments they need.

My name is Lisa Bright. I am from Trussville, Alabama, and I am a loving mom to three children, a devoted wife, and a successful businesswoman. I have been blessed in so many areas of my life – but some of those blessings have come after unimaginable hardship. Seven years ago, we lost our baby boy, our youngest son Will, to a heroin overdose. Those words come no easier today than they did at the time we lost him.

My son Will was everything a mother could ever dream of. He was smart, kind and a genuine friend to all. But Will also had substance use disorder. I know that he tried his hardest to overcome his dependency, because I was with him every step of the way. Since his struggles began in middle school, I devoted a huge part of my life trying to help him – counseling, rehab, tough love, all my love. Some of these programs worked, temporarily; Will would get sober, but always relapsed when he tried to re-enter a community where drug use is still rampant.

When I think about what could have saved Will, I think about two ends of the spectrum. First, I believe there is a profound need for a place where individuals can transition out of rehabilitation and learn to build a strong foundation in recovery. Traditional rehabilitation facilities do not teach patients how to socialize without being high, or hold down a job, or to provide for themselves with the absence of substances. My husband and I founded the Will Bright Foundation (WBF) and its recovery center, Restoration Springs, and designed it to succeed where our son was unable to. In founding WBF, we pooled all the resources we could through friends, family and our community to create a space where individuals in recovery could come to fully heal before reentering society. We provide young men with a community. We provide job training and life skill classes in order to achieve what we call the ABCs – a job, a better job, and most importantly, a career. We are proud to have developed a safe place for individuals to learn, ask questions, and grow into productive members of society.

I also believe we should be doing everything we can to avoid leading people down the path to opioid use disorder in the first place. In addition to our daily work in recovery and treatment, we are also leaders in a national fight to prevent opioid addiction all together. WBF is a proud member of Voices for Non-Opioid Choices, a coalition in Washington, D.C., working to increase access to non-opioid pain management, so that no one is prescribed an opioid unnecessarily. Many people in recovery from substance use disorder fear seeing a healthcare professional, or having a necessary surgery, because it may lead to opioids being prescribed. The federal government could do much more to increase access to these lifesaving, non-opioid medications.

I try to see everything in my life as a blessing, even the hardest moments imaginable. After Will’s death, we could have lived out the rest of our lives in anger and bitterness. But we are choosing to create a new platform setting individuals seeking recovery up for success, and we are choosing to advocate with our lawmakers in DC to change the way we think about pain management and opioids in this country. Had Will lived, he would have spent his life caring for others; I’m sure of that. We are choosing to honor his memory the way he would have wanted us to – on the frontlines of the epidemic that took him from this Earth too soon.

My name is Kimberly Robbins. I am a proud United States veteran and a substance abuse coach and counselor. My experience with substance abuse, specifically opioid dependence, goes well beyond my professional title.

As a soldier, I suffered a traumatic injury that resulted in the need for major hip surgery. After surgery, like nine in ten patients in America, I was prescribed opioids to manage my postsurgical pain, which is where my dependence to prescription pain medication began. I slowly became aware of my growing dependence on opioids, but it came too late and I struggled throughout the next year to overcome my battle. The withdrawal symptoms created a dangerous cycle I was scared I would never break out of. My biggest fear was that my children would find me dead of an overdose. I vowed to never let that happen.

After coming out of the agonizing journey of opioid use disorder, I have made it my personal mission to help as many people touched by the crisis as I can – and to prevent many more from ever having to know the struggle. I reside in the Upper Peninsula of Michigan and am proud to be able to use my personal experience to help others who are struggling in my state and community. I work to advocate through every avenue possible, whether that be through local community events or on the national stage before Congress.

For a crisis that is complex and multifaceted, we must develop a comprehensive solution that tackles the problem on all fronts. When I think about how to mitigate it, I think about my own journey. I became dependent on opioids after surgery; we must all work together to limit the number of opioids in our communities by increasing access to non-opioid options. I took advantage of unused opioids from family and friends; we must work on safe disposal of these dangerous medications. I struggled to find help; we must bring increased recourses for those in recovery.

One national organization I am proud to be a part of is Voices for Non-Opioid Choices, a group working to take federal action to ensure patients have increased access to non-opioid options for managing pain after surgery. I did not have a non-opioid option to manage pain after my hip surgery, but I am optimistic that many patients, especially women, will have the option in the future.

My life’s work is focused on bringing awareness on how opioid addiction or dependence begins and ensuring no one goes through that struggle alone. Increasing knowledge to not only the threat opioids present, but to the effective alternatives that exist, is crucial to ending the opioid epidemic. Until this crisis is over, I will keep using my story to help others.

My name is Kayla Leinenweber. On paper, there was nothing about me that would’ve given anyone any inkling that I was addicted to opioids. I didn’t have a terrible childhood; my family was, and still is, loving and supportive; extracurricular activities were the norm; I was very active in sports.

There was never one specific aspect anyone could point to that could justify my drug use, but that’s how addiction works. It’s a disease that doesn’t discriminate. Anyone can be affected, anywhere.

A knee injury in a high school soccer game ended a promising collegiate career and introduced me to opioids. The injury was pretty bad, and the recovery was a bit more painful than expected, but when it became tolerable, I discovered that I really enjoyed opioids and continued to take them. That was the start of it.

The word “addiction” never crossed my mind until I was addicted to opioids. It didn’t take long for things to escalate. Eventually, when I couldn’t find pills, I went to heroin.

For a long time I was high-functioning. I worked, had my own place, had my own car. At the time, I thought, “See, I’m not an addict! I’m too smart to be one.” That was a lie. I wasn’t smarter than anyone. It just took me longer to spiral out of control.

My parents, in the meantime, did everything they could to try and save me from this disease. They let me live at home, which gave them a sliver of peace. They gave me money when I needed it. They sent me to all of the best treatment centers money could buy. But I wasn’t there yet. I went to more than 10 inpatient and outpatient facilities when all was said and done.

I knew deep within me that my use was a problem, but it was nothing I was willing to change. Nothing beat an opioid, at least in my mind. In a very short span, my use resulted in three near-fatal overdoses. If it weren’t for Narcan, there’s a good possibility my story would’ve never been told.

At the end of my substance use, I was a complete shell. Every single thing I did or thought was guided by heroin. I was no longer a person but a vessel that existed to get drugs. In the end, heroin took everything I had except my life. I was homeless. My entire life was contained in two trash bags. It was when I had nothing left to give that I sought help.

Today, I’m just over a week away from achieving 6 years of sobriety. Every day I realize how fortunate I am. Since my recovery journey, I’ve been working in the addiction treatment industry, and I’m now an outreach coordinator at American Addiction Centers, helping people who are currently living the life I once lived get the treatment they need and deserve.

It’s humbling to help others carve their own path of recovery, because I know how amazing being sober can be. It’s something I will always continue to do.