In the opioid crisis, women face unique challenges, barriers to care

The opioid epidemic is a national public health emergency, with more than 130 Americans dying each day. According to a recent study in the American Journal of Public Health, without intervention, the death toll may reach more than half a million between 2016 and 2025. While the opioid epidemic has received widespread attention, its impact on women has been understudied.

Men are currently more likely to die of an opioid-related overdose, but rates of prescription opioid overdose deaths for women are increasing at an alarming pace. According to data from the National Center on Health Statistics, between 1999 and 2017, the number of prescription opioid-related deaths increased by 600 percent for women, compared to 308 percent for men.

Women face unique challenges that put them at high risk for addiction.

“We know that women are more likely to experience chronic pain, which is one of the primary reasons that opioids are prescribed. Studies have shown that a prescription for as little as five days increases risk for long-term dependence, and there is evidence to suggest women become addicted faster than men,"said Melissa Ward-Peterson, postdoctoral associate with the Community Based Research Institute at FIU. "Added to that, women are approximately twice as likely to develop post-traumatic stress disorder, a known risk factor for addiction, and 80 percent of women seeking treatment for addiction have experienced some sort of physical or sexual assault in their lifetimes.

"When you combine all of these issues, it becomes easier to understand how this epidemic may be uniquely impacting women.” 

Current research isn’t telling the full story. While recent reports from the Centers for Disease Control and Prevention (CDC) show that overdose deaths are down for the first time in nearly 30 years, it is harder to track the nuanced way the opioid epidemic may be impacting women.

“Opioid use disorder is already highly stigmatized, and since a majority of primary caregivers are women, they may feel prohibited from seeking help because they worry about the repercussions on their families. Nobody wants to be known as an addict, especially if that may mean losing custody of your children. And that makes it that much harder to get treated before it is too late,” Ward-Peterson added.  

Highlighting the need for intervention, it is estimated that every 15 minutes a baby is born with neonatal abstinence syndrome (NAS). These newborns experience severe withdrawal symptoms at birth, including seizures.

“Rates of neonatal abstinence syndrome have increased more than fivefold between 2004 and 2014. Up to 80 percent of infants born to women with opioid use disorder will experience NAS,” Ward-Peterson said. “These numbers clearly indicate something significant is happening among women, and it is critical that we gain a deeper knowledge of what the opioid epidemic looks like for them.”

Ward-Peterson recently received a $50,000 grant through the Investigator Development Core at FIU’s Research Center in Minority Institutions (FIU-RCMI)—funded by the National Institute for Minority Health and Health Disparities—to study barriers to accessing treatment among women with opioid use disorder. Ward-Peterson’s research will support FIU-RCMI’s mission to develop and promote a national, clinical and behavioral research program addressing health inequities and disparities, particularly those associated with substance use problems and HIV among underrepresented minorities.

For her study, Ward-Peterson will focus on the barriers women contend with when seeking access to medication-assisted treatment (MAT), which combines behavioral therapy and medication to treat substance use disorders and is recognized as the gold standard for treating opioid use disorder.

“We really don’t have a full understanding as to what challenges women face when trying to access MAT, but we do know they are not receiving the care they need. With this study, I hope to figure out which barriers require targeted, community-based intervention, which should lead to more access and better care for women,” Ward-Peterson said

Ward-Peterson will conduct confidential, in-depth interviews with women who have opioid use disorder to better understand their stories and perspectives on the obstacles they face when seeking care. She will also conduct key informant interviews with health care providers and social workers.

She will then analyze statewide fire rescue data to determine areas, based on the locations of opioid overdoses, where women are most in need of MAT services, as well as the community-level factors associated with the availability of MAT facilities in those areas.