The Unexpected Addicts

The portrait of the “typical addict” has changed quite a bit over the years. We used to picture impoverished, strung-out junkies, but the emerging truth is that the face of addiction is looking more and more familiar.

As reported in the Washington Post, women are particularly at risk for developing a dependence on, or an addiction to, prescription painkillers and anti-anxiety medications. The “why” is simple. White women are five times more likely than white men to receive prescriptions for these types of drugs.

But if the cause is surprising, the results are downright devastating. Over the past 15 years, opioid overdose deaths among middle-aged women have jumped by a staggering 400 percent. The problem has become so significant it’s literally changing the overall death rates for this demographic. In Salt Lake City, middle-aged white women saw their death rate rise by 65 percent over those same 15 years.

Old Challenges, New Remedies

Another suspected factor in the rise of deaths among women from opioid abuse and overdose is menopause.

For years, hormone replacement therapy (HRT) was the go-to treatment for perimenopausal and menopausal women, but following a 2002 study that discovered higher risks of breast cancer, blood clots and heart attack among women receiving HRT, doctors began distancing themselves from the treatment. Many women turned instead to alcohol, painkillers and anxiety medications to deal with the symptoms such as trouble sleeping, anxiety, mood swings and incontinence.

The dangers of mixing such opioids with alcohol and other drugs is well-documented — but beyond that, it’s been found opioid use doesn’t really help with hormone imbalances the way they’re expected to.

Next Steps

What can we do about it? The first step is awareness. When questions were raised about the effects of HRT on menopausal women, doctors were quick to curb their use of that treatment. In a cruel twist of fate, further study seemed to indicate women under 60 had nothing to fear from HRT. But doctors heard the emerging concerns, and responded.

Now, there’s another crisis to respond to, and it has to do with the very different ways women and men are susceptible to drug dependency and abuse. Some 3.5 million women in the U.S. abuse prescription medications, in part because they’re more susceptible than men to the effects of mood disorders.

That’s not a judgment — it’s merely a fact. Women are more likely than men to be the primary caregivers for children, for a start, and experience the emotional ups and downs associated with their hormone changes.

The good news is, the sort of widespread awareness this challenge requires is already beginning to take hold. The surgeon general recently issued an open letter to every doctor in the country, urging them to exercise better judgment when prescribing opioid-based medications to their female patients.

Assigning Blame

As to who “caused” this epidemic in the first place? The chain of custody stretches back quite a few decades. It wasn’t that long ago that prescription narcotics of this type were provided mostly for short-term pain management only.

Unfortunately, that wasn’t to last. High-profile letters and studies published in the New England Journal of Medicine and Pain convincingly claimed few enough pain patients developed dependencies that prescribing them for long-term pain management no longer needed to be avoided the way it had been in recent years.

Naturally, Johnson & Johnson and Purdue Pharma, among others, wasted no time rolling out aggressive marketing campaigns to corner the market on long-term pain management. They began to target doctors specifically, with well-placed advertisements in medical journals and even non-profit medical associations, such as the American Academy of Pain Management.

The rest is history.

Clearly, there’s no one smoking gun or single culpable party. This is an epidemic years in the making, with a variety of fingerprints all over it — from unscrupulous pharma companies to credulous doctors.

What’s far more important than blame is that it’s finally getting the national attention it deserves.

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