Women and the Opiod Epidemic: A National Emergency

You may have seen a new ad running on TV: a nice-looking man with an embarrassing problem—constipation, brought on by his opioid use. He is awkward and hesitant, not because of his drug use, but because he is having an issue in the bathroom. There is a hint that it affronts his masculinity to admit this.

It seems that we have now developed drugs to deal with the side effects of a drug crisis, and that this is commonplace enough to warrant a TV ad airing on a cable news show whose usual sponsors are allergy meds and insurance companies.

Millions of people are prescribed painkillers every day in this country, and while some of them are in severe pain, a significant subset continue to use the drugs after the precipitating crisis is resolved. Many become addicted. A secondary effect of the widespread prescription of these drugs, which began in the 1990s, is a raging epidemic of drug abuse. According to The Washington Post,

“In 2015, more than 33,000 people died from overdoses of opioids, meaning prescription painkillers, heroin, fentanyl or any combination. That easily keeps pace here with fatal motor vehicle accidents and gun-related deaths.”

This week, The New York Times reported, “Drug overdose deaths in 2016 most likely exceeded 59,000, the largest annual jump ever recorded in the United States.” They estimated that there has been a rise of 19 per cent in the last two years alone and that drug overdose is now the leading cause of death for people under 50.

The hardest-hit victims of this epidemic are not the urban poor and people of color, as they were during the last heroin epidemic in the 1980s, but those who live outside of big cities in depressed small towns and rural and suburban areas.  While only 50 per cent of those who began using heroin before 1980 were white, now the number is almost 90 per cent. One reason for this is that physicians are less likely to prescribe painkillers to non-white patients.

The New York Times says, “Opioid addiction is America’s 50-state epidemic.” It has swept through New England, the Mid-Atlantic states, and the Rust Belt, where the jobless poor have few prospects and obesity and diabetes are epidemic. West Virginia has been devastated by the epidemic.  Joel Achenbach reports in The Post:

“ . . .The citizens of these communities are often falling victim to drugs, drink and suicide, the so-called diseases of despair. These diseases do not adhere to any obvious boundaries—they’re not limited by race, gender, geography, income or education. But they’ve found a great deal of traction in places facing economic decline and social stagnation. That describes much of rural and small-town America and certainly the industrial areas of the so-called Rust Belt.”

A typical user might start out with a prescription for OxyContin from a doctor, or even a dentist who has pulled her wisdom teeth. The pain—both physical and, importantly, emotional—is abated. The Times says about one young woman, “For as long as she could remember, pills made the intolerable possible.” The pills are expensive, however, selling on the street for as much as $80 each.  Heroin, in contrast, is widely available and much cheaper. But unlike prescription drugs, it is unregulated and unreliable.

Fentanyl has also joined the roster of cheaper drugs on the street. It is extremely powerful, and synthetic, dangerous versions of it are widely available, sometimes sold as heroin to unsuspecting victims who don’t realize they are ingesting a much stronger dose than usual. Overdoses are so common in some communities that good Samaritans have taken to carrying Narcan, a drug that can reverse the effects of an OD and save lives if administered in time.

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