When Jen Simon gave birth to her second child via cesarean section, she says, her doctor didn’t ask her if she had a history of addiction. In the hospital, she was allowed two Percocet every four hours.
“If the nurses weren’t watching me, I would take one and I would palm the other,” she told Rewire, “Because I didn’t need it pain-wise, and I wanted to have it.”
Simon had become addicted to the pills after having her first child; she wrote for a piece on Babble that it was her way of self-medicating for postpartum depression. When she learned she was pregnant again, she stopped taking prescription painkillers—but in the traumatic aftermath of her second c-section surgery, she just couldn’t say no to more pills.
Like many U.S. women prescribed opioids after giving birth, Simon had found herself in a position where she was dealing with emotional and physical distress, and looked for release via a doctor’s prescription pad. For a long time, Simon says, she convinced herself that her addiction was benign; at least it wasn’t heroin. But, as she wrote for the Washington Post, she realized the seriousness of her problem when she found herself stealing drugs from her friend’s dead father’s medicine cabinet.
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The country’s “opioid crisis” has gotten a lot of attention recently—most notably from President Donald Trump, who last month brought attention to it as a “health emergency” although he did not commit federal funding to the issue, as he had suggested he would. But researchers told Rewire that sweeping declarations like Trump’s can gloss over the complexity of this problem. Furthermore, they said, they can distort our views about who is most vulnerable to addiction. The “crisis” entails many different substances affecting many different populations, they said—and when it comes to prescription opioids specifically, women are often overlooked.
“There’s this perception among first responders and the public in general that it is a male issue, given that there are more men than women on illegal opioids,” said Dr. Lorraine Greaves, a clinical professor at the University of British Columbia who co-authored a study on gender differences in prescription opioid addiction throughout North America. This image is bolstered by campaigns like this one from the Centers for Disease Control and Prevention (CDC), which focuses on prescription opioids specifically and which features six stories about men’s addiction and only two about women. But this assumption that most addicts are men is potentially deadly; a recent study of overdose deaths in Rhode Island showed that women were three times less likely than men to get Naloxone, a potentially lifesaving drug, during overdose resuscitation efforts.
In fact, when it comes to prescription opioids, multiple studies show that women are more vulnerable to physical dependence. Research released in September shows that women are 40 percent more likely to become persistent users of opioids after surgeries performed both on men and women. And while more men still die of prescription drug overdoses than women, that gap could close: According to the CDC, the number of women who died from prescription opioid overdose increased 400 percent between 1999 and 2010, while it increased 265 percent among men.
There are a number of factors that might contribute to women’s increasing dependency on prescription opioids—chief among them that they are more likely than men to be prescribed opioids in the first place. A 50 percent increase in births via c-section in the last 15 years, and the overprescription of opioids for recovering c-section patients like Simon, contributes to this trend. Simon says that she went home with 60 Percocet after delivering her second child—twice as many as she’d gotten after her first c-section.
Female bodies also metabolize opioids differently, and women respond to pain differently than men; both of these factors increase their vulnerability to addiction, according to Greaves’ research. Studies have also shown that doctors treat women’s pain less seriously than men’s, which may make them more likely to ultimately treat pain with opioids rather than addressing underlying factors.
Gendered trauma—including trauma from sexual violence and childbirth—can also feed dependency.
“Women, as a gender, experience such high rates of abuse and violence that it makes perfect sense that we’re seeing such levels of addiction among women,” says Dr. Hanni Stoklosa, an emergency physician at Brigham and Women’s Hospital in Massachusetts and executive director of HEAL Trafficking, an organization that helps trafficking survivors, who are often women dealing with trauma-related addiction. According to one research review, women are twice as likely as men to develop post-traumatic stress disorder (PTSD) and four times as likely to have chronic PTSD. Prescription opioids can be especially powerful and dependency-inducing for those with unaddressed trauma because, according to Dr. Stoklosa, they address emotional as well as physical pain.
Marti MacGibbon, who works to help trafficking survivors who are also fighting addiction, told Rewire, “Trauma and addiction together become like a hurricane in the brain.”
But for women dealing with trauma and addiction at the same time, Stoklosa says, resources are scarce. “If I send somebody to a detox facility or drug rehab facility, it’s oftentimes coed,” she said. And, she continued, “They’re rarely trauma-informed.”
And shame makes it harder to deal with drug dependency and emotional pain. MacGibbon took issue with Trump’s apparent attitude toward opioid addiction during a recent speech in the White House’s East Room—in which he said “it’s really, really easy not to take” drugs. But according to MacGibbon, that’s just not always true: “Shaming people … doesn’t work, because [addiction] itself is fueled by shame and fear.”
MacGibbon was trafficked internationally in the 1980s and became addicted to stimulants. She is now in recovery. As an advocate, she has seen more traffickers use prescription drugs to control their victims. Some things have improved from when she first sought help; more mental health resources are available in the United States, for example. But there still aren’t nearly enough affordable facilities that address the complex toll trauma and addiction take on mental health.
As Stoklosa noted, “Places that really do the deep work of addressing underlying trauma and abuse are only available via private pay. They’re not facilities that are Medicaid-accessible.”
In her recovery efforts, Simon found that the conflation of different types of opioid addiction and users can make it difficult for women to get the support they need. She says that in her experience, Narcotics Anonymous meetings tend to be dominated by men recovering from heroin addiction, and that this can make it hard to talk about pill addiction. Meetings specifically for pill addicts exist, but are harder to find, she says.
The Trump administration has has taken some steps to address opioid addiction, including an initiative that would specifically help pregnant and postpartum women. But the initiative does not help women who are not mothers or soon-to be mothers. And organizations like Human Rights Watch have pointed out that addressing opioid addiction while cutting funding for health programs that could temper the underlying causes of addiction—like the mental health–care mandates in the Affordable Care Act and Medicaid—could be a self-defeating plan.
Even fewer resources are available to help trans women specifically, whose addiction patterns have been studied little, but who could very well be at high risk given their vulnerability to sexual assault and mental distress. Greaves says we need more data on how trans women might be vulnerable to prescription opioids specifically—especially those who have undergone gender confirmation surgery and been prescribed pills to recover from it. Existing research does show that a high percentage of trans women take prescription pills recreationally, and that they are vulnerable to addiction in general.
Stoklosa says she wishes she had more tools and training to help her care for women who suffer from trauma and addiction.
“I’m an emergency medicine doctor and I like to fix things,” she says, but admits that she doesn’t always have the tools she needs, especially in complex situations—she wants to help her patients by making them feel heard and offering an array of services. “There’s so much attention that’s being to paid to treatments of the problem of opioid addiction after the fact, and we need to stop the revolving door.”
“We need to have programs in place that address underlying trauma for women and addiction at the same time,” she continued. “Or we’re just going to be chasing our tails.”