Unique Challenges of Women Abusing Prescription Drugs

Ever since opioids became popular as a drug of abuse in America, women have been at the receiving end. While the rates of drug overdose incidents more than quadrupled since 1999, it is also apparent that women have been affected more by the opioid epidemic than men. Coast to coast, the number of women who have inadvertently used prescription drugs and have become dependent on them has significantly increased.

A new report by the Agency for Healthcare Research and Quality (AHRQ) has revealed that there is a surge in the number of women who have been admitted to hospitals for drug-related incidents, including heroin and prescription painkillers. The report was compiled based on a national database that includes hospital statistics from more than 40 states. Along with a detailed account of the opioid epidemic, the report also sheds light on the emergency department (ED) and inpatient stays for both men and women in drug-related incidents. Some of the highlights of the report are as follows:

Inpatient stays: While more men had inpatient stays than women (145.6 vs. 127.8 per 100,000 population) in 2005, there was a dramatic increase in opioid-related inpatient stays in case of women between 2005 and 2014. This represented an increase of 75 percent for women and 55 percent for males. It is a matter of concern to note that the rates of opioid-related inpatient stays for males and females became more or less similar (225 vs. 224.1 per 100,000 population) by 2014.
ED visits: While males had the higher rates of ED visits than females (99.9 vs. 78.6 per 100,000 population) in 2005, the opioid-related ED visits nearly doubled for both males and females (males: 103 percent increase; females: 95 percent increase) in a decade.

Some of the other observations noted were as follows:

Opioid-related ED visit rate increased faster than inpatient stay rate: Between 2005 and 2014, the rate of opioid-related ED visits increased faster than the rate of opioid-related inpatient stays. For men, the numbers were (103 ED visits vs. 55 inpatient stays) and females (95 ED visits vs. 75 inpatient stays).

Opioid-related hospitalization for women topped in three states: The number of women hospitalized in Maryland, West Virginia and Massachusetts for opioid-related issues was above par. While the average rate of hospitalization stood at 225 per 100,000 people for opioid-related incidents, these states had more than 350 hospitalizations per 100,000 people.

While the data is open to further investigation, Anne Elixhauser, co-author of the study, says, “While none of these data are very encouraging, it is critical to have a better idea of why women are being hospitalized more than men, or why 25- to 44-year-olds are visiting the emergency department more than other age groups.”

Implicit biasness toward women’s unique needs in health care domain

As is apparent from several studies, because of a number of biological, psychological and hormonal factors, women tend to have more chronic pain. During puberty, pregnancy and menopause – three distinct phases of a women’s life when she experiences and endures pain – consumption of any addictive drug can prove to be quite dangerous due to the hormonal and psychological changes witnessed.

Therefore, a woman should consult an expert while taking drugs during such phases. Unfortunately, instead of facilitating pain management techniques, there is a tendency among health care professionals to prescribe opioids and painkillers to ensure immediate results. Moreover, due to the implicit bias in the health care domain, women are likely to be prescribed opioids of a comparatively higher dosage and for a longer duration than men.

The U.S. Department of Health and Human Services (HHS) has highlighted how women are impacted by the use of prescription opioids. Apparently, women are more likely to get addicted to prescription drugs, especially painkillers, compared to men. They are also likely to suffer from severer withdrawal pangs than men.

The bias is prevalent in the way naloxone, a potential lifesaver for opioid overdose, is made available to women. A 2016 study on emergency medical services (EMS) for resuscitation efforts in case of opioid overdose has made this biasness in emergency treatment public. There are differences between males and females when it comes to treatment from opioid overdose.

Despite being aware of their addiction, women are less likely to seek help. Unlike men, women avoid treatment due to the inherent fear of shirking their domestic responsibilities. Because women are stereotyped as a nurturer and the flag bearer of moral values, most of them feel that talking or seeking treatment for their abuse would cause stigma and shame to their family.

Road to recovery

Not every woman who falls into the clutches of addiction is a hard-core addict, and not everyone experiments for the high. Most women have genuine reasons for using prescription opioids. The only flaw in their story could be that they were not aware or not told when to stop. Therefore, the need of the hour is to spread awareness among patients before dispensing prescription drugs.

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Opiate Rapid Detox

Advancement in the field of neuroscience has identified how a change in a person’s mindset can alter his or her perception of pain. Besides the common risk factors, other elements, such as tissue damage, psychology, and environment, play a significant role in determining the way a person perceives his or her pain. The tailoring of new, innovative and improved medications to address acute or chronic pain that are commonly marketed as prescription opioids has assisted people overcoming all kind of pain.

Mental disorders, such as anxiety disorders and depression, uniquely add a range of unpleasant emotional feelings that tend to exacerbate physical pain. These disorders greatly dictate the way pain is experienced that suggests that mood disorders, especially depression and anxiety, can aggravate pain, as well as alter a person’s thoughts, behaviors and quality of life.

Due to the worsening of pain, a large number of prescription painkillers are prescribed to adults with such mood disorders. This ever-growing trend has become a matter of concern due to the close relationship between opioid abuse and mental disorders. This demands a thorough reflection over the kind of medications being prescribed to people.

51% of prescriptions go to adults with mental disorders

A study published in the Journal of the American Board of Family Medicine suggests that adults with anxiety and depression are consuming excessive amounts of prescription pills. The study by the researchers from the Geisel School of Medicine at Dartmouth and the University of Michigan has been published at a time rife with the problem of opioid addiction in the United States.

Although the prevalence of mental disorders is only 16 percent among adults, approximately half of all prescription opioids are consumed by them. This highlights a major gap in the distribution of prescription painkillers, especially among people suffering from mood disorders. From the 115 million prescriptions written for opiates every year, 60 million are meant for the individuals with mental illnesses. This is quite an eye-opening data that demands adequate remedial measures.

Brian Sites, a professor of anesthesiology and orthopedics at the Dartmouth-Hitchcock Medical Center and lead author of the study, said, “Pain that you may report as a two out of 10, someone with mental health disorders- depression, anxiety- may report as a 10 out of 10.”

While prescription opioids could improve depressive symptoms in the short-term, individuals with depression are more likely to experience intensified pain and are less able to cope with it. As a result, individuals with mental disorders are more likely to appeal to the doctor for more opioids.

Doctors may be beguiled into prescribing more pain pills

To ascertain the prevalence of prescription dependency among the individuals with anxiety and depression, the study used national surveys of 2011 and 2013. The respondents provided information on their health and medication regimen. Based on the data and response, the researchers found that over 7 million people out of 38.6 million individuals with anxiety and depression are prescribed opioids each year. The findings suggest that adults with mental disorders are more likely to use prescription opioids (18.7 percent) than those mentally sound (5 percent).

The study also sheds some light on how doctors may be coerced to overprescribe opioids in the case of individuals with anxiety and depression. Most often, opioids are administered for a range of reasons, such as injuries, physical pain and recovery from an operation. However, due to the potent euphoric effects of these medications, there is a huge risk of developing an addiction to them in a very short span of time.

Because mental disorders and substance use share a notorious affinity for one another, it can be an arduous task for doctors to gauge a patient’s pain levels accurately. At times, even well-meaning doctors are susceptible to overprescribing pain pills while being empathetic to their patients. In addition, almost half of all opioids are prescribed by a primary care physician who is also no stranger to individuals with mental disorders.

Dealing with addiction

Opioid addiction has hit the U.S. badly. However, opioid abuse is also found to be colliding with the increased prevalence of mental disorders, such as depression and anxiety disorders, which are aggravating the misuse of opioids. These two conditions also tend to coexist in many cases that can lead to a more complicated diagnosis of co-occurring disorders.

Stages of Change During Recovery From Drug Abuse

Change should come from within, so said a famous saint. And the words of wisdom hold true in case of drug abuse for sure. For most people who have been unwillingly dragged to a rehab or a therapy center, the moment of epiphany comes only when they realize that they are the agents of change.

Unlike most physical ailments that could take anywhere between a week and a month to get completely healed, substance abuse, especially if one has been into it for years, can turn into a bane of one’s life. More importantly, while a detox could get the drugs off one’s system, it is harder to get him or her off drugs even after a detox therapy.

Estimates point out that nearly 50 to 90 percent of people suffer from a remission or relapse post detox and rehabilitation. The numbers are considerably higher for people who have only undergone a detox. This is because unlike most physical ailments, substance abuse is keyed in to the brain.

When one experiments with speedball, cocaine or lysergic acid diethylamide (LSD), there are imprints left in the key areas of the brain associated with memory and reward. As a result, an individual is reminded time and again of the euphoric delights of ecstasy. However, once the individual realizes that he or she is the agent of change, it is easier to curb negative behaviors and the chances of remission.

Six stages of change have been underlined by Prochaska and DiClemente in their transtheoretical model that explains the changes in the behavior of substance users pre- and post-therapy. The stages or phases of change that a user could go through are underlined below:

Pre-contemplation: It is the state wherein the substance user is yet to be made aware of the existence of a problem. Most people who use drugs, especially teens, are not ready to acknowledge that they have a problem. They are consistently living in the denial mode. Similarly, adults who fail to seek treatment for their drug-induced behavior and justify their drug addiction as a means of getting over their existential woes are in the pre-contemplation phase.

Contemplation: This is the phase when the individual becomes aware of the pros and cons of his or her drug abusing behavior, such as homelessness and unemployment. However, he or she is still uncertain about investing time and energy in the treatment due to the unpredictable results. Therefore, the desire to change over a period of time comes only after weighing all factors.

Preparation: In the stage of preparation, users are mentally prepared for undergoing treatment and are ready to own the responsibility for the consequences. This stage opens the door to undertaking a life-changing decision by making all preparations. Now, the individual finally enters a program, whether it be a 12-step program or an inpatient program for detoxification, therapy and counseling.

Action: The action stage arises when the person knowingly practices behavior with or without the help of family and peers that is steered towards a life without substance abuse. In order to ensure mental, physical and emotional recovery, users engage with addiction recovery programs. By now, the patient is aware of the triggers responsible for motivating the practice of substance abuse. It is a test of his or her willpower. Apart from the regular visits to a counselor, one could fall back on the means that have been tried and tested, such as “journaling” or engaging in “strenuous exercises” to defeat the urge. Legendary rocker Eminem reportedly ran 17 miles each day to ensure that he stayed clean. For many, exercise is one of the best way for staying sober, as it gives a significant “endorphin” rush.

Maintenance: The longer one stays sober, the lesser are the chances of witnessing a relapse. One can remain sober by maintaining the lifestyle and behavioral changes, such as regular exercise, dietary changes, positive thinking, etc. And, as mentioned earlier, users are comparatively aware of the triggers and are in position to safeguard themselves from them by undertaking precautionary measures. An earlier study with regard to alcohol abuse found that the chances of a relapse decreases drastically after one manages to stay sober for five years. The studies on the remission in the case of alcoholism have suggested that after five years of abstinence, the risk of relapse is around 15 percent.
Termination: During the stage of termination, a user is extremely clear about his objectives and is ready to bear any kind of loss to stick to his or her commitment to sobriety. He/she considers it an impossible idea to return to his/her former lifestyle and behaviors.

Road to sobriety

Drug addiction can be treated with a great degree of efficacy, be it through inpatient therapy or a rather flexible plan for rehabilitation. Being aware of the problem is the first and foremost perquisite for treatment. Thereafter, one prepares for detox, wherein the accumulated toxins are removed gently. Interventions like experiential therapies could also be a part of the treatment. As this period is marked by the high chances of a relapse, guidance of an expert is a must. Avoiding the trigger patterns, reminding oneself to stay strong in the face of temptation and engaging in behaviors that preempt a relapse ensure a successful recovery.