Women Chasing Dragons: The opioid epidemic has reached an all-time high. But little attention has been paid to the particular ways the crisis affects women.
When Alannah* is using, there isn’t time for much else.
“I don’t talk to anybody. I just kind of deal with it on my own … making secret meetings and trying to hide money, making sure it doesn’t look suspicious if it goes missing.”
For people in active addiction to heroin and other opioids, entire days and weeks can disappear as getting and taking drugs become the top, and sometimes only, priority.
After developing an eating disorder as a teen, being involved in an abusive relationship, and becoming dependent on Xanax, Alannah tried heroin for the first time at 24.
“I fell completely in love,” says Alannah, who is now 26 and living in South Carolina. “For the first time I felt peace, like, ‘Is this what everyone’s talking about when their antidepressant works?’ … I became addicted immediately.”
For 18-year-old Bel of Seattle, Washington, heroin and prescription opioid use became so all-consuming that she stopped going to school two years ago, about a year after her mother, who had her own addiction, introduced her to prescription painkillers to ease her menstrual cramps. Bel was lonely and depressed at the time, having just moved back in with her mother after living with extended family. The pills helped her sleep and made her feel care-free. She had no reason to think her addiction was a problem.
“It was just a casual thing, it was just something I did,” says Bel. “I would be excited to come home from school because I knew that I would have painkillers waiting for me.”
Heroin and other opioids have been in headlines all over the United States in recent years, at the center of an epidemic of addiction and overdoses. Opioids including OxyContin, Vicodin, and Percocet are highly effective at treating pain because they flood the brain with dopamine, the same chemical that’s present in large doses during activities that ensure our species’ survival—when we fall in love, breastfeed, eat, and drink water. In this way, opioids trick the brain into thinking it needs the drug in order for a user to survive—making them as addictive as they are effective at fighting pain.
Because of their addictive quality, for most of the 20th century doctors recommended opioids mainly for short-term use for acute pain. But in the 1980s and ’90s, the pharmaceutical industry began pushing doctors to treat chronic issues, such as back pain and arthritis, more aggressively. Doctors began to believe that unless a patient had a history of addiction, there was virtually no risk of him or her becoming dependant on OxyContin or other opioids.
Today, 21 years after the release of OxyContin, doctors and government agencies agree that the opioid overdose epidemic, which killed more than 30,000 Americans in 2015 (including 20,000 from prescription drugs as opposed to heroin), has a direct link back to the over-prescription of prescription painkillers that began in the 1990s. Many patients who become addicted to the euphoric feeling they get from taking pills like OxyContin orally eventually begin crushing and either snorting or smoking the drug for a more concentrated high, which makes an overdose more likely. And many who begin with OxyContin and other prescription painkillers eventually switch to using heroin, which is cheaper and relatively easy to find.
In addition to developing a physical dependence, many users also feel a powerful psychological pull toward opioids, even after only using once. People with opioid-use disorders describe the drugs as giving them a feeling of intense euphoria while also numbing them to anything unpleasant going on in their lives. If someone is dealing with depression, anxiety, overwhelming family issues, or painful memories of childhood, it isn’t hard to see why he or she would come away from their first OxyContin high eager for another experience with the drug.
“When someone tells me the [opioid] makes them feel perfect, they’re at very high risk of becoming addicted,” says Dr. Deborah Richter, who treats hundreds of opioid-dependent patients at her family medicine practice in Vermont. “Most people feel like shit on opioids … they feel like they’re in a fog and it’s not a pleasant feeling. But people who are prone to addictions, they feel perfect on it.”
For women, the opioid epidemic has unique implications on many levels. According to the Health and Human Services Department’s December 2016 report (page 3) on women and opioids, overdose deaths from prescription painkillers increased more than 400 percent among women between 1999 and 2010, compared to an increase of 237 percent among men.
The report also found (page 13) that women are more likely to be introduced to opioids by an intimate partner and use heavily with a boyfriend, while men more typically use after being introduced by a peer. The American Journal on Addictions (page 13) also finds that a history of abuse and trauma correlates strongly with a woman’s drug abuse; such a history was found in at least half of the women surveyed.
Substance abuse often leaves a trail of destruction in a woman’s life more quickly and unsparingly than in a man’s. Richter says she sees women dealing with different kinds of fallout from their addictions than men do—especially when she compares women and men who have children.
“You can end up with a couple that is heavily addicted together, and the woman, of course, is discriminated against more because she’s carried a child,” says Richter. “We tend to view them differently, like, ‘How come she can’t get her act together for the sake of this baby?’ That discrimination doesn’t seem to happen for the guy … How come he can’t get his act together?”
Erin Mayberry, 37, was forced to sign over custody of her two daughters to her mother when she finally went into treatment in 2014 after a decade-long addiction to opioids. She says the life of an addict is sometimes different for women than it is for men, because women with families will often attempt to keep up with their child-rearing obligations even after addiction takes hold.
“I think women get pulled in a lot more directions than men do,” she says. “Typically women will throw the kids in the car seat, go get their [drugs], and then next thing you know they’re getting pulled over or something [dangerous] happens in a house and they’ve got their kids with them. We rationalize and justify the living hell out of everything.”
Erin was a married, working mother of two in Richmond, Virginia while she was addicted to OxyContin and heroin. She started taking opioid painkillers after developing rheumatoid arthritis, and says she kept requesting higher doses of the pills until she could no longer find a doctor who would provide them. She then used OxyContin she got from a dealer until the drugs no longer had an effect on her and she needed to supplement with heroin.
This need to constantly increase dosage is a hallmark of opioid use disorder, and is part of why doctors today are urging caution when opening the Pandora’s box of opioid use.
“A lot of people refer to it as chasing the dragon,” says Erin. “You’re always chasing that elusive first high … It got to a point where it wasn’t a question of even getting high anymore. I could not get out of bed without two pills. And it ended with 12 to 13 [pills] a day and a gram of dope. That was me getting my kids to school, that was me going to work, that was me just being able to do the basic things I needed to do … It’s like your own personal jail, you can’t get away from it.”
Dr. Leana Wen is the Health Commissioner in Baltimore, which has one of the worst opioid epidemics in the United States. The nonpartisan health research group The Hilltop Institute estimates that nearly 25,000 people in Baltimore abuse opioids. Wen has made it her mission to turn the city’s crisis around.
Before she began overseeing Baltimore’s health department in 2015, Wen worked as an emergency room physician. She got a firsthand look at the frontlines of the opioid epidemic, where patients would often arrive at the hospital experiencing chronic pain after an accident or due to an ongoing health issue, and doctors were more than willing to hand them a prescription for an opioid painkiller. Last year the Centers for Disease Control and Prevention released new guidelines for prescribing these drugs after the opioid crisis became impossible for the government to ignore. But in Baltimore and other parts of the country, it will likely take years to undo the damage that over-prescription of opioids has done.
Prescription-happy doctors aren’t solely to blame. Dr. Wen remembers seeing many patients who expected opioids for minor injuries like sprained ankles.
“This is the culture of medicine that we’re practicing in,” she says. “Doctors absolutely have a role to play because we’re the ones who wrote the prescriptions … but patients and society also have a role to play because we expect this instant fix [for pain].”
Lindsey Greinke was one patient who was relieved to get an “instant fix” for a neck injury when she was just 12. Today, she’s the ambitious 28-year-old head of Hope Soldiers, the non-profit she founded in 2013 in the Seattle area. She is laser-focused on helping anyone suffering from addiction. She does outreach work on weekends, parking her car in parts of her Seattle suburb that are frequented by addicts, offering fresh sandwiches and Gatorade out of her trunk to anyone in need, and handing out information about how people without insurance can get into treatment centers.
Lindsey has been in recovery since 2011, when she got clean after years of regular OxyContin use and a three-month stint with heroin. When a doctor prescribed Vicodin for her neck when she was a pre-teen, the pills seemed like a godsend, instantaneously ridding her of depression and anxiety.
“I basically thought to myself, ‘Wow, this is exactly what I’m looking for,’” she says. “This completely numbs the pain, not just physically, but emotionally.”
Lindsey dabbled in opioid use for a few years after her first prescription, grabbing a couple of Vicodin pills any time she came across a bottle in someone else’s medicine cabinet, and relishing the fact that she could occasionally take something to lift her depression. Her use intensified when she was introduced to OxyContin as a recreational drug, one that she says she fell in love with immediately. OxyContin provided a more euphoric feeling than Vicodin; Lindsey says that crushing the pills, heating up the powder and smoking it made her feel high and numb at the same time.
In 2010, amid early rumblings of concern about the skyrocketing rates of opioid addiction and overdose, the formula of OxyContin was changed to make it next to impossible to crush and snort or smoke. That same year, Lindsey says OxyContin all but disappeared from her hometown of Everett, Washington, while heroin use exploded.
“When I couldn’t find [OxyContin] anymore, somebody offered me heroin to smoke,” she says. “It basically did the job that I was looking for it to do.”
Within three months of taking her first hit of heroin, it was clear to Lindsey that she was in way over her head. She had used OxyContin regularly, but she hadn’t experienced severe withdrawal symptoms in between uses. With heroin, she found herself having to smoke it almost constantly throughout the day—just to keep from feeling intensely ill from withdrawal—with excruciating headaches and the feeling that every muscle in her body was being stabbed by tiny needles.
Once an addict decides to go into treatment, the discomfort of withdrawal is just the beginning of a long and often painful journey to living in recovery. For many women who use heavily with a partner, getting into treatment can feel like abandoning a lifestyle they’ve become deeply entrenched in.
“I cannot tell you how many women have told me that that they felt like they were part of this glamorous Bonnie and Clyde lifestyle with their boyfriend,” Lindsey says. “You’ve got one person that you’re with all the time and you have to think about leaving them. You feel selfish because you want a better life, and what’s going to happen to them? It’s almost like the relationship is more of a drug than the actual drug is.”
During Bel’s two-year addiction to painkillers and heroin, the drugs she did with her mother were the glue that bonded them. They had never been close before, she says, but driving around to pick up drugs and smoking them was an activity they shared, and the chaos the drugs brought into their lives felt like a battle they were in together. They moved around a lot, staying with friends and acquaintances, and sometimes in the houses where they bought drugs.
But when her mother got a new boyfriend and started doing most of her drugs with him, that bond was severed. Bel ran away and detoxed 14 months ago under the care of her grandmother and aunt. She enrolled at a high school in Seattle for teenagers in recovery, where she’ll graduate this spring, and she began attending meetings with other recovering addicts on a weekly basis. Bel plans to become a substance abuse counselor after college.
“It’s something that I’m always going to know,” she says now. “I’m always going to know the feeling of heroin and what it did for me, and I’m always going to be addicted to that. But I think of how far I’ve gotten in life and what would happen if I went back to it. Drugs are not benefiting me at all. All they did was make me feel a certain way.”
About 10 percent of American adults report that they are in recovery from addiction to a substance or alcohol, while an estimated 2 million are, like Alannah, suffering from an active addiction to opioids. Pharmaceutical companies that began pushing doctors to give patients opioids for chronic pain in the 1990s have begun to pay for their part in the crisis: Earlier this year, Lindsey Greinke’s hometown of Everett, Washington, sued Purdue Pharma, the manufacturer of OxyContin, for not combating illegal sales of the drug in the area. It’s the latest of hundreds of suits against the company for their misleading marketing practices.
But doctors and patients need to do their part to stop the crisis from growing as well. Doctors have new prescribing guidelines they’re supposed to follow, put out by the CDC in 2016. The guidelines make sure patients don’t take opioids for more than seven days and that doctors keep track of whether they’ve gotten prescriptions elsewhere. Doctors and patients both need to consider alternatives to opioid medications for chronic pain, including physical therapy, over-the-counter pain relievers, acupuncture, and medical marijuana in states where it’s legal.
As Dr. Leana Wen says, many patients would do well to realize that not every pain needs an immediate cure—while others may need to become comfortable with speaking up in a doctor’s office if they’re prescribed a strong painkiller that doesn’t seem necessary. She notes that female patients especially have to make sure they’re not seeing doctors who are dismissive of their concerns.
“Women, we tend to look out for others around us and not necessarily for ourselves,” Wen says. “We also tend to be more hesitant to speak up to authority figures, including doctors, in part out of fear of not being taken seriously. It’s so important for everyone to speak up about their care.”
* First names used at the request of those interviewed.