Differences between men and women related to prescription drug use outcomes are complicated. The death rate for OPR overdose is higher among men than women, but since 1993, hospitalizations for OPR overdoses have been more frequent among women than men (4). During 2004–2008, women and men had similar emergency department (ED) visit rates related to nonmedical use of OPR and benzodiazepines (5). OPR prescribing and use patterns also differ by gender. Women are more likely than men to be prescribed OPR, to use them chronically, and to receive prescriptions for higher doses of OPR (6,7). This might be because the most common forms of pain are more prevalent among women, and pain is more intense and of longer duration in women than men (8,9). Women also might be more likely than men to engage in "doctor shopping" (receiving a prescription for a controlled substance from multiple providers), and more likely to be prescribed OPR combined with sedatives (10,11). Sex-specific health risks associated with long-term OPR use among women include amenorrhea and infertility (12,13). Finally, the progression to dependence on OPR might be accelerated in women, and women with substance use disorders are more likely than men to face barriers in access to substance abuse treatment (14,15). Taken together, these health concerns indicate a need to examine drug overdose deaths and ED visits among women to guide development of targeted prevention strategies.
Editor's Note: We have skipped the detailed Methods and Results part of the report which may be read by going to Source reference:
Mack KA, et al "Vital Signs: Overdoses of prescription opioid pain relievers and other drugs among women -- United States, 1999-2010" MMWR 2013; 62.
Conclusions and Comment
Since 2007, more women have died from drug overdoses than from motor vehicle traffic injuries, and in 2010, four times as many died as a result of drug overdose as were victims of homicide. Men are more likely than women to die from drug overdose; however, between 1999 and 2010, the percentage increase in the rate of overdose deaths was greater for women (151%) than for men (85%). The prescribing of controlled substances, drug overdose deaths, and drug misuse- and abuse-related ED visits among women have risen despite numerous recommendations over the past decade for more cautious use of OPR and efforts to curb abuse and prevent deaths.
Between 1999 and 2010, OPR overdose deaths increased more than fivefold among women (a total of 47,935 OPR overdose deaths during that period). Abuse of OPR is a particular problem for women of childbearing age. Given the risk for neonatal abstinence syndrome as a result of OPR abuse during pregnancy (16), and the potential effects of OPR on an embryo during the first trimester (17), health-care providers should include discussions of pregnancy plans within the context of treatment and monitoring of patients taking OPR for medical or nonmedical reasons. Women treated for OPR abuse should be counseled regarding risks to the fetus of OPR abuse during pregnancy. The risks and benefits of treatment of chronic conditions with OPR during pregnancy should be weighed carefully (18). Use of benzodiazepines and antidepressants during pregnancy, or at any time in combination with OPR, also should be considered carefully by women and their health-care providers. Psychological conditions, which might co-occurr with pain or substance abuse (19), need to be assessed and addressed within a treatment regime.
The findings in this report are subject to at least four limitations. First, vital statistics underestimate the rates of drug involvement in deaths because the type of drug is not specified on many death certificates. Second, injury mortality data might underestimate by up to 35% the actual numbers of deaths for American Indian/Alaskan Natives and certain other racial/ethnic populations (e.g., Hispanics) because of the misclassification of race/ethnicity of decedents on death certificates (20). Third, all the drugs involved in ED visits might not be identified. Fourth, information on the motivation for use might be incomplete; some ED visits might have resulted from suicide attempts. Finally, distinguishing between drugs taken for nonmedical and medical reasons is not always possible, especially when multiple drugs are involved.
Public health interventions to reduce prescription drug overdose must strike a balance between reducing misuse and abuse and safeguarding legitimate access to treatment. Health-care providers who treat women for pain should follow prescribing guidelines. Providers should screen all their patients for psychological disorders and for use of psychotherapeutic drugs, either with or without a prescription. Checking state prescription drug monitoring programs before long-term prescribing of controlled substances should be a standard of care. Communities should try to increase access for women, especially pregnant women, to substance abuse treatment services. Medicaid programs, which enroll disproportionate numbers of young women, should ensure that the prescribing of controlled substances to their clients meets established guidelines. Overdose deaths and ED visits related to prescription drugs, especially OPR, continue to be unacceptably high, and targeted efforts are needed to reduce the number of deaths in this epidemic.
Reported by
Karin A. Mack, PhD, Christopher M. Jones, PharmD, Leonard J. Paulozzi, MD, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. Corresponding contributor: Karin Mack, kmack@cdc.gov, 770-488-4389.
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