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).

Women experience pain differently than men

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.”

Women experience opioid use disorder more than men

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 deathsamong 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.

Women need gender-based 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.

Learning more about gender-based treatment

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.