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Women, Opioids, Benzos, and Alcohol

Rates of overdosing and drinking are getting even worse in the pandemic.

A recent study completed by Rand of 1540 individuals revealed that men and women were binge drinking (4+ drinks for men within two hours and 3+ or more drinks for women) more this spring than in the spring of 2019. Overall, people’s binge drinking increased 14%. Women’s rates were higher at 17%. Women who already drink heavily are drinking even more heavily. Unsurprisingly, researchers found that women were experiencing an increase of 41% in alcohol-related problems as identified in the Short Inventory of Problems. These problems include, among others, feeling ashamed about their use, doing impulsive things, damaging close relationships and their own reputation, and using other drugs more. How many women will develop a substance use disorder remains to be seen.

Women are overdosing on a variety of drugs. From 1997 to 2017, the overall death rate for women ages 30 to 64 from overdoses has increased 260%. As a report from the Centers for Disease Control and Prevention (CDC) notes, “During this time, rates of drug overdose deaths increased for those involving synthetic opioids (1,643%), heroin (915%), benzodiazepines (830%), prescription opioids (485%), cocaine (280%), and antidepressants (176%).” The largest increases in this group were women between the ages of 55 and 64. This probably surprises many people.

Prescription opioids and benzodiazepines are often prescribed together even though each carries the most serious “black box” label from the Food and Drug Administration. Benzodiazepines (benzos for short) are prescribed for anxiety, panic, and insomnia. Some of the more common ones include Xanax, Valium, and Klonopin. Benzos work on the neurotransmitter GABA to calm and sedate. One of the effects of sedation is depressed breathing, which is also an effect of opioids. Both opioids and benzos cause cognitive impairment, contributing to many people making decisions they may not have otherwise. Add alcohol, which is a disinhibitor, and the chances of accidentally overdosing rise even more. Benzos are found in 30% of people who overdosed and survived and in nearly 25% of overdose deaths.

While much attention has been focused on the increased prescriptions for opioids, the rate of benzo prescriptions has increased in similarly startling ways. From 1996 to 2013, the number of adults prescribed benzos increased from 8.1 million to 13.5 million. Not only did the number of people filling prescriptions for benzos increase, so too did the number of pills in each prescription. Women, older people, and non-Hispanic whites have higher benzo use than other groups. The group that has the highest use of benzos is aged 50 to 64.

Women who are in their 50s and 60s and older may be caught in the perfect storm for overdosing. Women are twice as likely as men to experience general anxiety disorder and panic disorder. Women are also twice as likely as men to suffer from depression. The question of why has many answers. Financially, women are in precarious shape. The wage gap between white men and women has remained relatively stable for decades. While white women earn 79 cents to every dollar white men earn, the gap expands substantially for Black (62 cents), Latina (54 cents), and Native (57 cents) women. The compounding effects of these gaps over a lifetime of labor are significant in terms of homeownership, savings for retirement, and contributions to Social Security. Many women are legitimately terrified of financial insecurity. Those fears increase exponentially as one gets older and recognizes she will have even fewer options for employment and security.

Women also tend to do a far greater share of all the caring labor in a family than men. Whether it is taking time off from work to care for sick children or taking work shifts that enable more home-based childcare, women bear the brunt of the work. Older women aged 50 to 65 may be caring for elderly parents, adult grown children, and grandchildren simultaneously. This caring labor is both physically and emotionally draining, causing stress and anxiety about the immediate present and the not-too-distant future. It is a small wonder that women can’t sleep and can imagine every possible bad scenario coming to pass.

Nearly one in three women experiences some violence by an intimate partner. For one in four women, that violence is severe. In the context of a relationship in which one should feel safe and secure, many women instead are victimized and terrorized by their partners. Fear and stress are inseparable. Living in a heightened state of alertness is utterly exhausting and debilitating. Small wonder many women can neither hope for nor imagine better futures.

Now add in all the ways that these realities are even more dire in a pandemic, and there is an even greater perfect storm for women to overdose. Whether it is looking for more ways to cope with stress, manage accelerating levels of anxiety, or just get a good night’s sleep, women are susceptible to overdosing when there are opioids, benzos, and alcohol ready at hand. Some of the overdoses will be intentional but many of them will be accidental. They’re equally tragic. The conditions driving them are not just a matter of “personal choice” or individual circumstances. They are structural or systemic dimensions that shape choices and constrain the lives of women. As such, they require systemic forms of redress. While politicians, activists, and public policy experts look at the structural dimensions, others encounter real women struggling enormously. Physicians in prescribing, social workers in assessing, psychologists in diagnosing, teachers in educating, and ministers in preaching must be more attuned in understanding the ways in which the burdens women carry every day are staggering.

More from Peg O'Connor Ph.D.
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