Content Warning: this article discusses drug use.
The opioid crisis in North America is real and terrifying — and its pace has increased rapidly during the COVID-19 pandemic. Fatalities from opioid overdose reached record heights in the US last year and continued to climb throughout 2020. In the Canadian province of British Columbia, there have been 911 overdose deaths between January and July this year, more than four times the number of deaths from COVID-19.
More generally, data from urine drug tests conducted in the US show massive increases in fentanyl, methamphetamine, and cocaine use. A combination of contaminated drug supplies and social isolation brought on by the pandemic is fueling a silent crisis, and policymakers are struggling to keep up. With heartbreaking stories from families of overdose victims and staggering numbers, analyzing the gender aspect of the opioid crisis may appear trite. However, addiction is a long-term process and often lifelong, and addicts’ lives are shaped by gendered expectations and social burdens as much as any other member of society.
Men and opioids
Statistics show that a nuanced approach is absolutely essential: in British Columbia, 80% of fatal overdoses happen to men. Dr. Dan Bilsker, a clinical psychologist, dubs the opioid epidemic a ‘crisis of masculinity.’ Dr. Bilsker believes that opioid addiction is intimately connected to societal pressures on men, which already leads to higher rates of suicide and lower life expectancies.
Opioids act as a temporary numbing agent for psychological pain, which men are often reluctant to seek professional help for; in addition, higher rates of workplace injury and overprescribed painkillers are often what lead men to opioid abuse in the first place. Opioids’ impact on men can be directly traced from gendered stigmas, and approaches to improving outcomes must actively work against social pressures.
Women and opioids
Relatively fewer women are active opioid users, yet CDC research shows that women who live with addiction experience its impacts more acutely. Women progress faster from use to dependence, and the psychological toll of addiction is often more pronounced: rates of comorbid psychiatric disorders are shockingly high. Chronic pain is a particularly common complaint among women: 65% of total opioid prescriptions in the US were written for female patients.
Women are especially susceptible to long-term opioid use after surgeries like hysterectomies or colectomies. These all lead to a deeply worrying rise in opioid use among women: between 2003 and 2012, rates of heroin use among American women doubled. Women’s addiction issues have additional consequences when compounded with reproduction: substance usage can double the possibility of stillbirths and lead to neonatal abstinence symptoms, putting infants at risk of painful withdrawals and long-term damages.
This image of motherhood creates particularly adverse effects for women struggling with opioid misuse, as they are perceived as failed caregivers and undeserving mothers. They may avoid getting help for fear of having their children taken away, or even feel too ashamed to seek prenatal care when they are pregnant.
For mothers, treatment programs that often last months and require isolation from the rest of society are almost always inaccessible due to a lack of childcare. Economic inequalities also take a toll: on average, women earn less than men, and lower socioeconomic statuses are directly connected to lack of healthcare access, less education, and a higher likelihood to abuse opioids.
LGBTQ+ people are generally more likely to use legal and illegal substances, and the community has sadly not been spared from the opioid epidemic. Healthcare researchers tend to understand the phenomenon in the context of ‘minority stress:’ ostracization since childhood, isolation from families, experiences with homophobia, and a need to escape from challenging emotions all to lead to higher risks of substance misuse and worse health outcomes. 58% of LGBTQ+ people between the ages of 35 and 44 report having been prescribed opioids, compared to their cisgender, heterosexual counterparts.
This is particularly relevant for transgender people: though not all trans people desire or choose surgeries for gender affirmation, those who do are often given opioids for pain management; as a result, up to one-fifth of transgender people in the US report opioid use. We also lack research into the impact of opioid misuse treatment when it coincides with hormone replacement therapy (HRT), antiretroviral therapy for HIV, PrEP, etc., making the experiences of LGBTQ+ people in accessing care even more treacherous.
The way forward
At the moment, CDC guidelines on opioids make no mention of gender. This clearly needs to change: addiction affects people of different genders differently, and medicine cannot be disentangled from social experiences. Public health approaches have to differentiate according to gender identities and create specific, targeted options. Moreover, a robust and sufficiently studied gender context will allow policymakers to establish new adjacent programs such as childcare provisions during treatment, workplace safety measures, and disability support.
Mental health is never simply an issue of awareness and stigma: it requires scientific approaches combined with societal awareness and a fairly distributed social safety net that allows for alternatives to drug use.
To neglect the impacts of patriarchy and heteronormativity on the opioid crisis does a deep disservice to those living with addiction, and creates false images of opioid addiction that mislead our society. Opioids’ unequal impacts are symptoms of inequality rather than causes, and addressing the drugs without addressing inequality itself will never be sufficient.