Apr 8, 2022
Show Notes for Episode Twenty-One of seX & whY: Opioid Use Disorder
Host: Jeannette Wolfe
Dr Alyson McGregor, author of Sex Matters: How Male-Centric Medicine Endangers Women's Health and What We Can Do About It
Dr Lauren Walter
Here is link to American Psychiatric Association DSM 5 diagnosis for opioid use disorder from the CDC. Essentially the disorder is defined by continued craving and use of opioids despite significant social and professional consequences caused by its use.
This podcast is on sex and gender differences in opioid use disorder. Although sex (s) and gender (g) are rooted in different etiologies - biological sex via innate chromosomal and hormonal characteristics while gender is heavily influenced by sociocultural factors, they are often heavily interconnected. Experiences influence gene expression through epigenetics and if a man is exposed to different experiences than a woman, they can have different epigentic responses. Further complicating things, however, is that if a male and a female have the same experience, they can have a different pattern of gene expression because the process of epigenetics itself is influenced by innate sex. Currently, if researchers are even looking for s/g differences in their data, they are usually doing so at a very basic level like patient reported demographics, this makes further exploration as to whether discovered differences are rooted in innate physiology or cultural influences difficult. Essentially, appreciating the current limitations of research, we will use the term “men” and “women” in this blog.
To highlight how recent the trend in research has been to even consider the potential influence of sex and gender as relevant factors in pain. A 2007 study that looked at over 10 years of research published in the journal Pain, found that almost 80% of their studies included only male animals and less than 4% looked at sex differences.
CDC- Opioid deaths accounted for > 70% of all deaths from drug overdoses (totally overdose deaths 70,630)
2019 Kaiser Family Foundation data
Opioid Overdose Deaths
2019 total deaths
2020 data https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm - total overdoses > 93,000 estimates that 69,710 from opioids.
For comparison 2020 mortality numbers for car crashes were 38,680
Sex and Gender Differences
Overall, in women compared to men, the prescription opioid abuse is decreasing more slowly while heroin use in increasing more quickly.
“From 1999 to 2010, overdose deaths increased 265% among men and 400% among women (CDC, 2018)”
Once in treatment have similar outcomes
Multidimensional approach - medical and psychosocial needs - these may be different for men and women
Sex and Gender gaps in the literature
Socioeconomic differences between typical methadone vs buprenorphine users
Increasing comprehensive services such as: housing, childcare and social support can help both men and women but what type of services they need and utilization of services may be sex/gender specific
May increase women’s participation by adding women support group and childcare services
Take Home Points
There are sex and gender physiological and sociocultural factors that come into play in substance use disorder
Finally, we talked about Alyson’s important work with the Sex and Gender Summit which is geared towards integrating sex and gender-based principles across health care curricula to better educate future providers.
Here are two great resources to learn more on how to do searches to include sex and gender: