Women who are managing chronic pain or recovering from surgery or a traumatic injury may face a dilemma: Is it safe to take opioid pain medications? Opioid drugs such as oxycodone, codeine and morphine have their place in pain control when used as directed, but they can cause dependence and addiction in some people.

Jessica Peirce, Interim Director, Addiction Treatment Services & Center for Addiction and Pregnancy at Johns Hopkins, and associate professor of psychiatry and behavioral sciences, sheds light on women’s risks of developing opioid use disorder.

Chronic Pain: A Risk Factor for Women’s Substance Use Disorder

Studies show that women are more likely than men to have chronic pain conditions, which may account for the comparatively high number of women of reproductive age being prescribed opioid pain relievers.

For example, women suffer from migraine headaches and neck, facial and lower back pain at up to twice the rate men do. According to U.S. Centers for Disease Control and Prevention (CDC), new diagnoses of rheumatoid arthritis are two to three times higher in women than in men. The National Institutes of Health report that middle age women account for 75% to 90% of people diagnosed with fibromyalgia.

“In general, women have a lower threshold for acute pain than men, although it is not clear whether they experience chronic pain any differently,” says Peirce. “Cultural and societal influences also affect pain experiences. In some cultures, it may be more socially acceptable for women to ask for help, while men may feel they have to endure discomfort without complaint. In addition, traditionally held roles of child and home care must continue regardless of pain, which may result in greater use of opioids to maintain functioning.”

Women and Opioid Use Disorder

According to data from the National Institute on Drug Abuse (NIDA), patterns in opioid use disorder among women can be different from those in men.

In general, men are more likely than women to use illicit drugs. But some research points to a higher likelihood of women medicating chronic pain with prescription narcotics and a greater tendency to self-treat anxiety and depression with opioids.

Research indicates that long-term opioid use may produce changes in the brain that can make some people more sensitive to pain. That, in turn, can make them need more painkillers to get relief.

Also, misuse of prescription opioids may be a factor that leads to using heroin and fentanyl. According to NIDA reports, 80% of people who use illicit opioids misused prescription opioids first. In some areas of the U.S., heroin is cheaper and easier to obtain than prescription opioid drugs. Because heroin is a street drug and may be mixed with other even more toxic and deadly ingredients such as fentanyl, there is a higher risk of accidental overdose.

An accidental overdose can also occur by taking a mix of legally prescribed medications, or by drinking alcohol along with prescription drugs. Women (and men) who are taking more than one prescription medication should check with their doctor to see if the drugs have dangerous interactions.

“Anyone who is taking opioids should consider having an opioid overdose reversal treatment available and show members of their household how to use it,” Peirce recommends.

Women’s overdoses are on the rise

According to the CDC, fatal drug overdoses among women ages 30 to 64 increased by 260% from 1999 to 2017, with many of these deaths were caused by opioids.

Why is this happening? There are multiple reasons why women are increasingly affected by the opioid crisis, says Peirce.

“Overdoses happen when people take more opioids — legal or illegal — than their body can handle,” she says. “Importantly, the overdose ‘window’ gets smaller as someone increases the amount and frequency of their opioid use. Women who are on chronic opioids may not realize their risk of overdose is increasing.”

Symptoms of Opioid Use Disorder

Signs of opioid tolerance that signal it’s time to consult with a doctor include:

• Taking opioid pain medication more frequently than prescribed
• Needing frequent refills or running out of medication early
• Experiencing breakthrough pain

Another sign of physical opioid dependence is experiencing withdrawal symptoms in the absence of medication, such as:

• Agitation and anxiety
• Sweating
• Runny nose or eye
• Insomnia
• Muscle aches
• Abdominal cramping and diarrhea
• Nausea and vomiting

“A final important sign of possible opioid use disorder is continuing to take opioids even though they are causing you medical, social or legal problems,” Peirce says.

Opioid Alternatives

Optimal medical care balances pain control with avoiding unhealthy opioid use and opioid use disorder. While some women may do well on long-term opioids, others should work with their doctors and choose other, safer medication types and pain control strategies, including:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen or naproxen
• Nonopioid medications, including some antidepressants and medications for nerve pain that have proved useful for chronic pain
• Physical therapy
• Massage therapy
• Heating pads
• Acupuncture
• Exercise
• Weight loss
• Cognitive behavioral therapy to learn strategies to cope with chronic pain

Anyone who suspects they are misusing opioids or have become dependent on them should talk to a doctor about next steps. Opioid use disorder and other substance use disorders can be treated successfully. FindTreatment.gov is a resource to find help in your area.