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The opioid epidemic is growing disproportionately among women. From 1999 through 2016, mortality rates for opioid overdose increased 507% among women, compared to 321% among men, according to the National Institute on Drug Abuse. Deaths related to prescription opioid as well as heroin use increased at nearly twice the rate for women as for men.

There is no question about the tragic dimensions of the opioid epidemic for people of all genders, their families and their loved ones. However, decades of research have taught us that women experience substance use, addiction, and treatment differently than men. For example, women transition from substance use to addiction more quickly than men, and they are less likely to participate in traditional substance abuse treatment programs. We need to apply this knowledge to the opioid epidemic and ensure women’s needs are met. Understanding and serving women who use opioids is vital to an effective public health response.

Polysubstance use—the consumption of more than one drug at once—is one aspect of the opioid epidemic that is particularly relevant to women. A recent national study of women who used opioids for nonmedical purposes found that 89% used additional substances, suggesting that “polysubstance use is the norm.”  

Benzodiazepines and alcohol are particularly worrisome in this regard. As depressant drugs, the use of either substance along with opioids greatly increases the risk of opioid overdose. Since 1999, there has been over a 1,000% increase in the number of fatal overdoses among women using opioids and benzodiazepines at the same time. More than 3,700 U.S. women died from this drug combination in 2016 alone. Furthermore, women are more likely than men to receive concurrent prescriptions of opioids and benzodiazepines, enhancing this risk. Our recent research conducted in Oakland, California, showed that a third of women who used illicit opioids in the past 30 days had also used benzodiazepines.

Alcohol is the most common secondary substance found in opioid overdose deaths. In our research, we found that three-quarters of women who used opioids also used alcohol—and half reported binge drinking, consuming four or more drinks in a single sitting. The hazards of binge drinking in the context of opioid use have received little attention, despite the implications for overdose.

Fortunately, there is an extensive body of research on substance use among women to inform our response. Harm reduction services, such as syringe exchange and naloxone distribution, are essential. Medication-assisted therapy for opioid dependence needs to be widely available and available on demand. An emphasis on treatments that recognize the relationship between trauma and substance use is vital, as study after study has established the pervasive presence of trauma among women who use drugs. Similarly, the frequent occurrence of gender-based violence speaks to the importance of offering programs and service venues that create safe spaces for women.

In response to risks of polysubstance use, educational messages can emphasize the need to carefully manage or eliminate the concurrent use of substances. We know many of the answers to helping women survive the opioid epidemic—let’s implement them.

Disclaimer: This piece was written by Jennifer Lorvick (Senior Public Health Scientist, Community Health and Implementation Research Program) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.