Women Face Increased Risk of Prescription Opioid Misuse

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While men have a higher risk for opioid-related deaths, this mortality gap is closing as women are increasingly at risk for misusing prescription pain relievers.

Opioid misuse is a U.S. public health crisis that does not discriminate based on gender.¹ National Women’s Health Week (May 8-14) is a good time to spotlight just how women are being affected by the inappropriate use of prescription drugs—and what can be done to stop it.

Recent prescription pain-reliever data from the Centers for Disease Control and Prevention (CDC) reveal alarming trends. Women are more likely than men to be prescribed opioid pain relievers, use them longer, be given higher doses, and be hospitalized for an overdose.²

The good news: State and federal policymakers can take actions to help treat and prevent opioid use disorders.

1. Improve prescription drug monitoring programs

Prescription drug monitoring programs (PDMPs) are one prevention strategy. These statewide electronic databases track the dispensing of certain controlled substances, including opioids, and can help prescribers and pharmacists identify patients at risk for substance use disorders before the disease takes hold.

PDMPs have shown to be effective in changing prescriber behavior and reducing the number of patients who visit multiple providers seeking the same or similar drugs.

Although 49 states have PDMPs, clinicians report that accessing these data is a time-consuming process, so use of PDMPs remains suboptimal in most states.

States are now exploring strategies for improving the usability and functionality of PDMPs, such as:

• Using prescription data to alert prescribers when patients may be engaging in drug use that puts them at risk for harm.
• Allowing nurses or other medical professionals to obtain PDMP reports on a doctor’s behalf to address prescriber time constraints.
• Integrating PDMP data into electronic health records for easier access.

2. Expand patient review and restriction programs

Bipartisan legislation already on Capitol Hill would authorize patient review and restriction programs, or PRRs—another important tool to protect some of the most vulnerable patients at risk for opioid abuse.

Opioid abuse can start when patients seek pain relief from multiple prescribers and pharmacies at the same time—a tactic often referred to as doctor shopping. Because doctors and pharmacists often don’t know that these patients are also seeking help elsewhere, the patients may obtain unsafe amounts of prescription drugs, placing them at higher risk for addiction, overdose, and death. 

Many health plans and state Medicaid programs use PRRs, which identify these patients and assign them to designated doctors and pharmacies for their controlled substance needs. These programs make sure that patients get the pain relief they need but don’t have access to dangerous amounts of drugs. People who need high doses of pain medication, such as those with cancer or in hospice, are often exempt from these programs.

PRRs have found success in Medicaid and private insurance plans. But current federal law prohibits using PRRs for Medicare recipients—even though they, too, are at risk of opioid abuse. 

Congress is poised to change that. The House of Representatives has already voted to lift the Medicare restriction on PRRs, and similar bipartisan legislation has passed in the Senate. 

3. Increase access to medication-assisted treatment

President Obama has made substance use treatment a priority, as evidenced by his proposed fiscal year 2017 budget, which calls for $1.1 billion to tackle this epidemic, including expanding access to such services. At the National Rx Drug Abuse & Heroin Summit in March, he also announced a plan to further expand access to treatment.

The president’s plan includes $50 million in new funding to help states expand access to medication-assisted treatment (MAT), which uses medications to relieve withdrawal symptoms and cravings in conjunction with behavioral health interventions. The drug buprenorphine, approved by the Food and Drug Administration to treat opioid dependency, is one example.

Studies have shown that MAT is effective in helping patients. Research consistently shows that illicit opioid use is reduced by over 40 percent on average by patients treated with MAT.

In addition, the proposal calls for doubling the number of patients that a physician who prescribes buprenorphine for substance use disorder can treat, from the current 100 patients to 200.

Allowing nurse practitioners and physician assistants to prescribe buprenorphine would also be a positive step. However, the administration cannot lift this restriction on its own.  Only Congress can make that change—and it should.  

The need for change is urgent. Seventy-eight Americans die from opioid overdoses every day, the CDC reported. In fact, more people died in 2014 from prescription opioid overdoses than in any year on record, according to the latest CDC data. The strategies outlined above can, and should, be part of the solution.

Cynthia Reilly directs The Pew Charitable Trusts’ prescription drug abuse project.

Endnotes

1. Centers for Disease Control and Prevention, Multiple Cause of Death 1999–2014 (2015), http://wonder.cdc.gov/mcd-icd10.html. Data are from the Multiple Cause of Death Files, 1999–2014, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
2. George J. Unick et al., “Intertwined Epidemics: National Demographic Trends in Hospitalizations for Heroin- and Opioid-Related Overdoses, 1993–2009,” PLOS ONE, 8, no. 2 (2013): e54496, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054496; Cynthia I. Campbell CI et al., “Age and Gender Trends in Long-Term Opioid Analgesic Use for Noncancer Pain,” American Journal of Public Health 100 (2010): 2541–7, http://www.ncbi.nlm.nih.gov/pubmed/20724688; and Rachel E. Williams et al., “Epidemiology of Opioid Pharmacy Claims in the United States,” Journal of Opioid Management 4 (2008): 145–52, http://www.ncbi.nlm.nih.gov/pubmed/18717509.