Wanted: Overdose Prevention Tailored to Women

By Leo Beletsky, Elena Moroz
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Over the past 20 years, the overall prevalence of fatal opioid overdose has tripled.  Historically, the risk of overdose among men had been significantly higher; over the last decade, however prevalence of opioid overdose deaths has been increasing faster among women than men. With the gender gap decreasing, women now face a greater risk for opioid drug overdose than ever before.

Women of all racial and socioeconomic backgrounds are facing greater risk of overdose from opioid drugs. Recent data sheds light on the role of pregnancy as one the possible channels for increasing opioid dependence, which is a precursor to overdose. In the past, neonatal abstinence syndrome had been documented primarily in underserved urban areas, it is increasingly observed in hospitals across geographical and socioeconomic strata.  However women who live in the South, Midwest and the East appear to be at an elevated risk than those in the West of the United States. Overdose is most common among middle aged women (45-55 years old).

Several factors attribute to female risk for opioid overdose. Women are 50% more likely than men to be prescribed opioid medication by their doctors. Likewise, women are prescribed anti-anxiety medication at twice the rate of men.  This increases the possibility of poly-drug use, which can contribute to the risk of opioid overdose. Female patients are also more likely to utilize health services, providing them with more opportunity to speak with clinicians about depression, pain management, and stress.

These and other emerging data highlight the reality that men and women may follow different paths towards opioid use, dependence and overdose. They also amplify calls for tailored prevention efforts targeting women. Women opioid overdose victims are more likely than men to have been prescribed pain medications from more than 4 doctors in the last year of their life, a drug seeking behavior called “doctor shopping.” In this context, interventions such as prescription monitoring systems may help better regulate patient access to powerful opioid medications and reduce the risk of overdose events. Attention to these and other gender-specific behaviors, along with general efforts to address stigma must be integrated into the design of comprehensive intervention strategies.