A White House Report on the Opioid Crisis Overlooks Gender Differences in Addiction

The report excludes studies showing that women experience pain and develop addictions differently than men—differences that mean women might not receive adequate treatment.
January 7, 2019, 10:13pm
Medical workers and police treat a woman who overdosed on heroin
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Two psychologists are criticizing the United States’ latest report on how to respond to the opioid crisis, stating that the report overlooks key sex and gender differences related to opioid addiction—differences they say mean that women might not receive adequate treatment. More than 15,000 women died of an opioid overdose in 2017.

Their commentary, published today in the journal Biology of Sex Differences, takes aim at a draft report by a committee of the White House’s National Science and Technology Council (NSTC), and calls for the group to revise the report to reflect the unique needs of women.

The October draft report outlines what research is needed to combat the opioid crisis in the United States, identifying seven key areas, which cover pretty much anything you could think of related to opioids: the biology of opioid addiction and pain, social factors, pain management, preventing addiction, treatment, overdose prevention, and the impact of opioid addiction on communities.

But, according to the commentary authors, the report leaves out close to a dozen studies citing social and biological differences between women and men related to those seven key areas, although it does mention the effects of opioids during pregnancy and on a newborn.

“I don’t know how it happened, other than looking at the composition of the committee. There really was no one on the committee who could speak to sex and gender issues related to opioid use [and treatment]. It’s not inherently obvious to them,” co-author Jill Becker, the biopsychology chair at the University of Michigan, tells me.

Becker believes some on the committee may have viewed the crisis from a management perspective, rather than a scientific one, although she admits she does not know them personally.

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Socially, women are more likely to have experienced mental health issues like anxiety or trauma—trans women even more so—that tie into their addictions. They are also less likely to seek treatment for fear of stigmatization or losing custody of their children.

Addiction treatment needs to allow women to feel in control, rather than giving control over to a higher, religious power as the 12-Step Program advocates. The authors note that attendance is higher, and women do better on, addiction programs that include domestic counseling and childcare.

Then there’s the biology. Based on rodent studies, scientists conclude that the brain and body circuitry that deals with pain is structurally different in females. This circuitry for reducing pain, as well as the brain receptors that latch on to opioid drugs, are also influenced by the female sex hormone estradiol (although exactly how remains unclear).

These rodent studies suggest that opioid drugs aren’t as effective at lessening pain in women and, as a result, women may be prescribed a higher dose, or take opioids for a longer time, the authors say.

But in other areas of the brain, particularly those associated with reward, opioids have a greater impact, meaning female rodents get addicted to drugs faster and have a harder time coming off them because the withdrawal is worse. Women are also more likely to relapse than men, the authors say.

Although the majority of studies were done in rodents, Becker explained that rodent brains are a good stand-in for humans and some findings, like women being more sensitive to the rewarding effects of particular drugs, are mirrored by human clinical trials.

“It’s a recipe for increased susceptibility for opioid abuse for women who are in pain,” Becker says.

The same likely goes for transgender women who are on hormone therapies, Becker says, as the hormones they take affect their bodies and brains in much the same way as cisgender women (but there are currently no scientific studies to verify this).

While Washington State University psychology professor Rebecca Craft agrees that rodent studies are useful for understanding the brain chemistry underlying addiction, she disagrees that opioids are less effective for women than men. There just aren’t enough studies to reach that conclusion and the jury is still out, says Craft, whose research focuses on sex differences in the effects of opioids, but who was not involved in either the commentary or the government report.

Still, Craft agrees that the situation is particularly dire for women. Treatment strategies for opioid addiction have largely been developed for men based on the numerous studies in male rodents.

“Any comprehensive plan to address the opioid crisis should take these sex differences into account if we want to provide the most effective interventions for everyone,” Craft says.

By ignoring these previous studies, and not calling for sex- and gender-based research in their report, Becker argues that prevention and treatment of opioid addiction will be less effective for women in the US.

“We need a lens that doesn’t think it’s OK for women to be taking prescription opioids for a long period of time when they’re in pain,” she notes. “We need other ways of allowing women to overcome the issues that they’re addressing."

“If, like animal models, women become addicted to opioids more rapidly… then we need an intervention strategy that steps in much more quickly in order to stave off the deaths and terrible consequences of addiction.”

Becker and her co-author Carolyn Mazure submitted their commentary to the committee who wrote the report in early December but have received no response as of today. Neither representatives from the report’s committee nor the NSTC responded to Tonic’s requests for comment by phone and email but we’ll update this story if we hear back.

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