Dr. Jones: In the tragedy of the opioid epidemic, a new group of Americans has emerged as the most likely to die of prescription opioid overdose -- middle-aged women. These are mothers and grandmothers. How can this be? This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is The Scope.
Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.
Dr. Jones: Women are the fastest growing segment of alcohol and drug users in the United States. Up to 4.5 million women over the age of 12 in the U.S. have a substance use disorder, and 3.5 million misuse prescription drugs, 3.1 million regularly use illicit drugs. That would be heroin or marijuana in states that don't allow it. Each year, over 200,000 American women die as a result of alcoholism and drug dependence, with more than 4 million women in the need of treatment for their addiction. Men are more likely to use opioids, including heroin and illegal narcotics, than women and are more likely to die of narcotics overdoses related to illegal substances than women. But when the issue is prescription opioids, the kind you get from your doctor, the problem is shifted more to women.
The 2013 National Survey on Drug Use and Health estimated that 6.5 million Americans misused or abused prescription drugs within the last year, and more than half of them were female. Women are more likely to experience chronic pain and anxiety than men, and are more likely to seek help from clinicians for these problems, and are more likely to use a combination of opioids and valium-like drugs than men, and that combination can be lethal. They're more likely to get and use prescribed medications, such as opioid pain relievers, sleeping pills, and tranquilizers than men. And middle-aged women are more likely to have chronic pain and anxiety than young women.
As a clinician, I must say that I used to think my patients, particularly those that were older in midlife, were older and wiser and were too smart to use or abuse prescription drugs, and I was wrong. And all of us who care for women need to take special care now. More women have died each year from drug overdoses than from motor vehicle accidents since 2007. Drugs given to treat anxiety, called benzodiazepines, are often combined with prescription opioids, and the combination is particularly dangerous and causes many of the deaths and emergency room visits related to opioid overdose.
According to a recent study by the Geisinger Health System in Pennsylvania, the group most at risk for prescription opioid overdose is made up of white, middle aged women, not the ones you'd think, huh? The study came from examining over 10 years' worth of health records comprising some 1.2 million patients and had the goal of predicting which people were at most risk of overdose from prescription opioids, like hydrocodone and OxyContin. Some of their findings were the average overdose patient in women was 52 years old. The majority of overdose patients were unmarried, unemployed females, but they probably weren't unemployed before their addiction problems started.
Almost 10% of patients who overdosed died within a year of that incident, meaning if you overdosed once but got resuscitated, got helped, 10% of those women die in a year. One reason why this high rate of increase for women is because the Centers for Disease Control reported that women may be more likely than men to engage in doctor shopping. Doctor shopping is when women actively seek out multiple types of prescription drugs from multiple providers. So they go to one doctor for one prescription and another doctor for another.
There's evidence that women become addicted to prescriptions such as narcotics and benzos much more quickly than men. This has been found for alcohol and nicotine as well, and it's not just that women are smaller because pound for pound, women became drunk faster than men and addicted more easily. It's probably a combination of biology and psychology of women.
This trend is alarming as women progress faster than men into addiction even when using a similar or lesser amount of substances, and ultimately suffer more health-related consequences. And while addiction is an equal opportunity disease, women become addicted differently, starting for different reasons, progress faster, recover differently, and relapse for different reasons than men. Women have a higher percent of body fat and lower percent of body water than men, both of which can affect how the drug is metabolized, and women are 70% more likely to suffer from depression than men. They're twice as likely to struggle with anxiety, post-traumatic stress disorder due to sexual abuse, violence, or childhood trauma.
So what should we be doing? As clinicians, we should be very careful in how we prescribe narcotics and benzodiazepines and sleeping pills. We should understand that women become addicted more quickly than men. After surgery or delivery, we should send women home with only the amount of narcotics needed and should be tailored to each woman, and we should be checking the prescribed medication databases to see if our patients have been getting these drugs from other clinicians if they're doctor shopping. We should be using alternative therapies for pain, anxiety, and insomnia where possible.
As caregivers, we need to be on the alert that our mothers, our sisters, our friends, and our daughters are in trouble. Changes in behavior, withdrawal from family, changes in sleeping patterns, these aren't necessarily signs of alcohol or narcotics addiction. It could be depression or anxiety, but the woman needs help. As women, we need to do our best to avoid the use of narcotics and anti-anxiety drugs like benzodiazepines or sleeping pills.
Anyone can become addicted in a matter of just a few days. If you've had an injury or surgery, use narcotic pain relievers first if possible. If you're seeking help for anxiety, try behavioral approaches first. And if you have problems with sleeping, behavioral approaches work better than sleeping pills in the long run. And if you believe that you have a problem, then you probably do. Tell someone, get professional help, there is a road back, and thank you for joining us on The Scope.
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