IRETA Blog: Women Have Been Particularly Affected By the War on Drugs, Part II

“How can we use what we know about women and the War on Drugs to create real drug policy reform?

In our first installment about women, addiction, and the criminal justice system, we shared some stark facts about the impact of “War on Drugs” policies on American women.  Here are two:

  • The number of women in prison has grown by over 800% in the past three decades. The female prison population grew by 832% from 1977 to 2007. The male prison population grew 416% during the same time period.
  • Two thirds of women in prison are there for non-violent offenses, many for drug-related crimes. In the 10-year period from 1999 to 2008, arrests of women for drug violations increased 19%, compared to 10% for men.

This blog addresses three ways to make drug policy reform matter to women.

  • Expand alternatives to incarceration
  • Improve access to treatment for incarcerated women
  • Make prisons and correctional services more gender-responsive

The blog can be accessed at: http://iretablog.org/2014/03/14/women-have-been-particularly-affected-by-the-war-on-drugs-part-ii/

Source: Institute for Research, Education and Training in Addictions – March 14, 2014

Wider Use of Antidote Could Lower Overdose Deaths by Nearly 50%

“Distributing naloxone and training people to use it can cut the death rates from overdose nearly in half, according to a new study.

The new study, published in the BMJ, followed the expansion of Overdose Education and Naloxone Distribution (OEND) programs in Massachusetts.  The programs were offered at emergency rooms, primary care centers, rehabilitation centers, support groups for families of addicted people and other places that might attract those at risk.

The study involved 2912 people in 19 different Massachusetts communities — each of which had had at least 5 opioid overdose deaths between 2004 and 2006.  The participants were trained to recognize overdose, call 911 and administer naloxone using a nasal inhaler.  If the naloxone didn’t work, they were instructed to try another dose and perform rescue breathing until help arrived.

During that time, 153 naloxone-based rescues were reported for which there was data on outcomes, and in 98% of those cases, the drug revived the victim.

There are still practical barriers however, to widely distributing naloxone and implementing more OEND type programs. Advocates have argued that the medication should be made available over-the-counter since it has little potential for abuse and is nontoxic. The Centers for Disease Control (CDC), the director of the National Institute on Drug Abuse and even the drug czar’s office support making it more widely available, and unlike the case with needle exchange programs, there has been no organized opposition to OEND. But the Food and Drug Administration (FDA) has no precedent for allowing over-the-counter sales of such a drug: naloxone is a generic medication approved in an injectable form. Without a company to submit an application for its use in the intranasal version, the agency isn’t likely to OK over-the-counter sales.”

http://healthland.time.com/2013/02/05/wider-use-of-antidote-could-lower-overdose-deaths-from-by-nearly-50/

Source: HealthlandTime.com – February 5, 2014

Supreme Court: Heroin Dealer Can’t be Given Longer Sentence Because Client Died

Pg8_law“The U.S. Supreme Court unanimously ruled a heroin dealer cannot be held liable for a client’s death and given a longer sentence if heroin only contributed to the death, and was not necessarily the only cause.

The ruling is likely to result in a shorter sentence for Marcus Burrage, who received 20 extra years in prison because of his client’s death, according to USA Today. The decision is also likely to make it more difficult in the future for prosecutors to extend drug sentences, the article notes.”

International Journal of Drug Policy Celebrates its 25th Anniversary – 25 Free Downloads Available from Past Issues

Articles of interest related to opioid dependence and addiction include:

  • Gender sameness and difference in recovery from heroin dependence: A qualitative exploration – September 2013
  • Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness – August 2013
  • What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries – October 2013
  •  
  • Syringe access, syringe sharing, and police encounters among people who inject drugs in New York City: A community-level perspective – August 2013
  • “I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention – August 2013
  • Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users – June 2013
  • Does informing people who inject drugs of their hepatitis C status influence their injecting behaviour? Analysis of the Networks II study – December 2013

http://www.ijdp.org/issues?issue_key=S0955-3959(13)X0007-6

Source: International Journal of Drug Policy – January 2014

Study: Many Arrested Men Use Illegal Drugs But Don’t Receive Treatment

jail“More than 60% of men arrested in five U.S. cities used at least one illegal drug, but fewer than 15% received drug treatment, a government report found.

Data from the Bureau of Justice Statistics indicate that 68% of jail inmates, 53% of state prison inmates and 46% of federal prison inmates abuse or are addicted to drugs and alcohol.”

http://www.usatoday.com/story/news/nation/2013/05/23/half-of-men-arrested-used-drugs/2356033/

Source: USAToday.com – May 23, 2013

Are Drugs Today Really Cheaper, Purer, and More Available Than Ever? Blog by Rafael Lemaitre Communications Director, The Office of National Drug Control Policy

“You’ve probably heard this claim: Despite decades of effort, we’ve failed to make any significant progress in reducing drug use in this country. Some critics go so far as to say that “illegal drugs are cheaper, purer, and more available today” than ever before. This is a compelling argument and a powerful sound bite, to be sure. There’s just one problem: It’s not true.

So what do the data show? Simply put, our national drug problem is substantially smaller than it used to be, and progress continues to be made.”

http://www.huffingtonpost.com/rafael-lemaitre/are-drugs-today-really-ch_b_2670195.html

Source: HuffingtonPost.com – February 12, 2013

Drug Addiction: It’s Different—and Riskier—for Women

When it comes to drug addiction, gender does make a difference.

Women start using substances and become addicted differently from men. Their addiction progresses faster, they find it harder to quit, they recover differently from men, and they relapse for different reasons.

These gender differences have a substantial impact on treatment for substance abuse. But when women’s specific needs are understood and addressed from the outset, better treatment engagement and successful outcomes often follow.

Women and Addiction: The Biopsychosociocultural Framework

The Substance Abuse and Mental Health Administration TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women, proposes approaching substance abuse treatment for women from the perspective of “the biopsychosociocultural framework.”

Differences between women and men in genetics, physiology, anatomy, and sociocultural expectations and experiences lay the foundation for women’s unique health concerns related to substance-use disorders (SUDs). The biopsychosociocultural framework encompasses the impact of gender and culture and the contexts of a woman’s life, including her social and economic environment, and her relationships with family and support systems.

Risk Factors for Substance Use in Women

Some factors are associated more strongly with initiation of illicit drug use in women than with progression to abuse. They include risk-taking (as a personality trait), depression, obsessiveness, anxiety, and difficulty controlling behavior (as indicated by temper tantrums or tearfulness).

Genetics and environment both play a role in some risk factors. Parents who abuse substances may pass along a genetic susceptibility. They may also fail to adequately protect their children from abuse by others, and may be of little help to them emotionally. And they may unintentionally pass along the message that it’s okay to use substances to cope with problems.

Among other risk factors:

  • Divorce, never having been married, and widowhood (the incidence of SUDs in married women is only 4%)
  • Sexual or physical abuse or domestic violence in childhood or adulthood
  • A history of having adult responsibilities as a child: caring for younger children, performing household duties, emotionally supporting their parents
  • Unemployment or underemployment; low income; low education level
  • A partner who abuses alcohol or drugs (some women continue using substances in order to maintain the relationship, a situation that also occurs in some same-sex relationships)
  • Sexual orientation: lesbians have higher rates of SUDs than heterosexual women; younger lesbians and bisexual women are most likely to abuse prescription drugs

Protective Factors

Factors that help protect a woman against substance use, abuse, and dependence include a good marriage, a supportive partner, parental warmth during her childhood, religious affiliation and beliefs, and deep personal devotion.

Research Results: Characteristics of Women with OUDs

Women face a higher risk of co-occurring mental and physical disorders. A UCLA study examined gender differences in 578 men and women with opioid-use disorders (OUDs), drawn from the National Epidemiologic Survey on Alcohol and Related Conditions. The study found that “women were about twice as likely as men to have either a mood or anxiety disorder.” Women were also “more likely to have paranoid disorder, and men, more likely to have antisocial personality disorder.” Another study, the National Survey on Drug Use and Health, found higher rates of “serious psychological distress” and “cigarette use” related to non-medical use of prescription opioids among women, but not among men. In contrast, “serious psychological distress” was a significant predictor of abuse/dependence for both sexes.

Other studies have found that women are much more likely than men to have co-occurring mental disorders, often three or more, including anxiety disorders, major depression, eating disorders, and post-traumatic stress disorder (PTSD). Typically, PTSD follows trauma, sexual abuse, or violence—events that unfortunately are all too common in women with OUD. Physical disorders in women include gynecological infections, high blood pressure, amenorrhea (absence of menstrual periods) and pneumonia.

In a symposium report, Florence Haseltine, PhD, MD, noted that women tend to take illicit drugs to relieve stress; men, to get a high; women, for self-medication; men, as an adventure.

She added that women with OUDs are more likely to

  • Self-medicate, especially using drugs to manage negative moods
  • Need help for emotional problems, and at a younger age
  • Have attempted suicide

Others have observed that, in addition, women with OUDs tend to use more prescription drugs (and use prescription drugs that can be abused), obtain prescription opioids free from family or friends (men are more likely to buy them), and have partners who use illicit drugs.

Relationships and family history are key factors in women’s—but not men’s—initiation and continued illicit use of opioids and other substances. Women are more likely than men to have a family background of dysfunction and alcohol dependency, and to be brought into and maintained in drug use by a partner or family member. It almost seems that when women start to abuse substances, they already have three strikes against them.

Women are more likely to borrow needles and equipment from the person they inject drugs with. They’re also likely to inject immediately after that person—putting themselves at added risk of HIV and hepatitis infections. Intravenous drug use accounts for up to half the cases of HIV infection among women in the U.S., twice as many as sexual transmission.

But, importantly, women can temporarily change their pattern of substance use to meet caregiver responsibilities involving the family, such as pregnancy.

Looking Back When In Methadone Maintenance Treatment

In gender-specific focus groups in a methadone maintenance clinic at UCLA, comments from participants older than 50 years revealed clear differences between men and women in their views of their previous life in addiction. Women talked about the impact on their families, and their regrets about “. . . not being the mother I should have been.” And their remorse: “I almost lost my family.”  Men typically expressed surprise at still being alive, and previous fears about incarceration.

Pregnancy

If a woman’s menstrual periods stop when she is using opioids, she may assume at first that the early signs of pregnancy are symptoms of withdrawal or underdosing. This often delays her pregnancy diagnosis and prenatal care.

But, as TIP 51 points out, “Women are socialized to assume more caregiver roles and to focus attention on others.” Indeed, once a woman is told she is pregnant, she typically casts aside her vulnerability and regains her traditional role of caregiver. She is likely to accept medical care for herself and her unborn child, and to stop or substantially curtail her use of illicit drugs, alcohol, and cigarettes, throughout her pregnancy.

*     *     *

This article is the first in a series on the special challenges that make coping with addiction especially difficult for women. Future topics include the barriers women face in seeking and accepting treatment, and the best approaches to treatment for women in medication-assisted treatment programs. Programs need to address the special needs of women by offering auxiliary or wraparound services, or both—such as child care and prenatal services, and workshops on woman-focused topics.

Resources

Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series 51. HHS Publication No. (SMA) 09-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009.

Becker JB, Hu M. Sex differences in drug use. Frontiers in Endocrinology. 2008;29:36-47.

Haseltine FP. Symposium Report: Gender differences in addiction and recovery. J Womens Health Gend Based Med. 2000;9(6).

Hamilton AB, Grella CE. Gender differences among older heroin users. J Women Aging. 2009;21(2):111-124.

Grella CE, Karno MP, Warda US, et al. Gender and comorbidity among individuals with opioid use disorders in the NESARC study. Addict Behav. 2009;34(6-7):498-504.

Grella CE, Lovinger K. Gender differences in physical and mental health outcomes among an aging cohort of individuals with a history of heroin dependence. Addict Behav. 2012;37(3):306-312.

Subramaniam GA. Clinical characteristics of treatment-seeking prescription opioid versus heroin using adolescents with opioid use disorder. Drug Alcohol Depend. 2009;101(1-2):13-19.

Back SE, Payne RL, Simpson AN, Brady KT. Gender and prescription opioids: Findings from the National Survey on Drug Use and Health. Addict Behav. 2010;35(11)1001-1007.

Researchers Say MRI Could Help Predict Success of Drug Addiction Treatment

Scientists at the University of Pennsylvania say MRI scans may be able to predict which patients will succeed with certain addiction treatments, and which ones will relapse, according to the Philadelphia Daily News.

Researchers at the university’s Center for Studies of Addiction are watching how regions of the brain react to drug-related photos, such as pictures of a heroin needle or a crushed pill. They hope to use this research to develop more effective treatments. One day, they hope that treatment could be tailored to a person’s mental strengths and vulnerabilities. These factors are influenced by genetics, life experiences and drug use, they say.

http://www.drugfree.org/join-together/addiction/researchers-say-mri-could-help-predict-success-of-drug-addiction-treatment?utm_source=Join+Together+Weekly&utm_campaign=16753ecc0b-

Source: JoinTogether.org – January 18, 2013

New Infographic From NIDA – Maternal Opiate Use and Newborns Suffering From Opiate Withdrawal Are On The Rise in The U.S.

Use of opiates during pregnancy can result in a drug withdrawal syndrome in newborns called neonatal abstinence syndrome (NAS). A new study to determine the extent, context, and costs of NAS found that incidence of NAS is rising in the US. The proportion of babies born with NAS tripled from 2000 to 2009, when an estimated 13,539 infants were born with NAS —equivalent to one baby suffering from opiate withdrawal born every hour.

The number of delivering mothers using or dependent on opiates rose even more—nearly five-fold—from 2000 to 2009, to an estimated 23,009. In 2009, newborns with NAS stayed in the hospital an average of 16.4 days (compared to 3.3. days for other newborns), costing hospitals an estimated $720 million; the majority of these charges (77.6%) were paid by state Medicaid programs, reflecting the greater tendency of opiate-abusing mothers to be from lower-income communities. The rising frequency (and costs) of drug withdrawal in newborns points to the need for measures to reduce antenatal exposure to opiates.

The full text description can be accessed at: http://www.drugabuse.gov/related-topics/trends-statistics/infographics/maternal-opiate-use-newborns-suffering-opiate-withdrawal-are-rise-in-us

Source: National Institute on Drug Abuse

Gateway Drugs Linked to Prescription Drug Abuse

Researchers at the Yale School of Medicine analyzed nationally-representative survey data to explore a possible link between alcohol, cigarette, and marijuana use as an adolescent and subsequent abuse of prescription pain medication as a young adult. Their paper, published in the Journal of Adolescent Health, was the first to find that a link between these “gateway drugs” and prescription painkillers. They found that all three drugs are associated with higher levels of prescription drug abuse in men, but only marijuana use is associated with higher levels of prescription drug abuse in in women.

http://www.yaledailynews.com/news/2012/sep/04/gateway-drugs-linked-to-prescription-drug-abuse/

Source: Yale Daily News – September 4, 2012

Scientific American: This is Our Society on Drugs: Top 5 Infographics


Infographics are graphic visual representations of information, data or knowledge that present complex information quickly and clearly. This compilation of infographics on addiction include:

  • This is Your Brain on Prescription Drugs
  • This is Your Body on Drugs
  • Prescription Drugs Go Figure
  • Medical Uses of Abused Drugs
  • Drug Use in Today’s Classroom

http://blogs.scientificamerican.com/white-noise/2012/04/20/this-is-our-society-on-drugs-top-5-infographics/

Source: ScientificAmerican.com  –  April 20, 2012

National Survey Shows a Rise in Illicit Drug Use from 2008 To 2010

The use of illicit drugs among Americans increased between 2008 and 2010 according to a national survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). The National Survey on Drug Use and Health (NSDUH) shows that 22.6 million Americans 12 or older (8.9 percent of the population) were current illicit drug users. The rate of use in 2010 was similar to the rate in 2009 (8.7 percent), but remained above the 2008 rate (8 percent).An increased rate in the current use of marijuana seems to be one of the prime factors in the overall rise in illicit drug use. Another disturbing trend is the continuing rise in the rate of current illicit drug use among young adults aged 18 to 25—from 19.6 percent in 2008 to 21.5 percent in 2010. This increase was also driven in large part by a rise in the rate of current marijuana use among this population.

Non-Medical Use of Pain Relievers

  • In 2010, the number of new users of pain relievers was 2.0 million, a number that has remained fairly constant since 2005 and was a decrease from 2002, 2003, and 2004 levels (2.3 million, 2.5 million, and 2.4 million, respectively). The average age at first nonmedical use of pain relievers was 21.0 years.
  • In 2010, the number of new nonmedical users of OxyContin® aged 12 or older was 598,000, with an average age at first use of 22.8 years among those aged 12 to 49. These estimates are similar to those for 2009 (584,000 and 22.3 years, respectively).
  • The majority (55 percent) of persons aged 12 and older who had used prescription pain relievers non-medically in the past 12 months received them from a friend or relative for free. Only 4.4 percent of those misusing pain relievers in the past year reported getting their supply from a drug dealer and 0.4 percent bought it on the Internet.
Heroin
 
  • In 2010, there were 140,000 persons aged 12 or older who had used heroin for the first time within the past 12 months. The average age at first use among recent initiates aged 12 to 49 was 21.3 years, significantly lower than the 2009 estimate (25.5 years).

As in previous years, the 2010 NSDUH shows a vast disparity between the number of people needing specialized treatment for a substance abuse problem and the number who actually receive it. According to the survey, 23.1 million Americans aged 12 or older (9.1 percent) needed specialized treatment for a substance abuse problem, but only 2.6 million (or roughly 11.2 percent of them) received it.

NSDUH is a scientifically conducted annual survey of approximately 67,500 people throughout the country, aged 12 and older. Because of its statistical power, it is the nation’s primary source of statistical information on the scope and nature of many substance abuse behavioral health issues affecting the nation.

The complete survey findings are available at:http://atforum.com/addiction-resources/documents/NSDUH2010.pdf

Source: The Substance Abuse and Mental Health Services Administration – September 8, 2011

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