Editorial: The Opioid Epidemic: Overcoming Challenges by Using A Sex and Gender Lens

Clinical Therapeutics/Volume 40, Number 2, 2018
Editorial
The Opioid Epidemic: Overcoming Challenges by

Using a Sex and Gender Lens
The opioid epidemic is America’s public health crisis. In 2015, 12.5

million people in the United States older than 12 years reported
misusing prescription opioids and 2 million people reported having
prescription opioid use disorder, up from 11.5 million and 1.9 million,
respectively, in 2014.1 No matter the causes for such a rapid rise, the
enormous risk of morbidity and death associated with opioid use and
abuse cannot be understated. Drug overdose is the leading cause of
death for Americans younger than 50 years, killing more people than
guns or motor vehicle accidents.2 In 2015, 33,091 people—90 people
per day—died of opioid overdose in the United States, and nearly one-
half of these deaths were attributed to overdose of prescribed
opioids.3,4
President Donald Trump has declared the opioid epidemic a
national public health emergency, which anticipates enhanced efforts
to identify those in need and to create effective treatment and Alyson J. McGregor, MD, MA
prevention programs.5 The accelerated use, abuse, and lethality
associated with the opioid epidemic together with the national interest in ameliorating its deathly toll brings to
light the need for understanding the who, how, and why of this epidemic. The knowledge that men and women
have different reasons and patterns of substance use and abuse could be the critical, lifesaving key toward change.
The medical and scientific research community is beginning to understand the vast impact patient sex and
gender has on health and illness. The appreciation that men and women can differ in disease pathophysiology,
symptom presentation, treatment response, and disease outcome can facilitate improved health outcomes through
tailored treatments. A greater understanding of how men and women may differ in the sociocultural factors that
contribute to drug use, predilection for the progression from initiation to addiction, opioid use disorder screening
challenges, and responses to intervention will become valued pieces of the puzzle toward overcoming the
challenges in designing effective strategies in prevention and treatment of opioid addiction.
This Specialty Update in Clinical Therapeutics is dedicated to The Opioid Epidemic: Overcoming Challenges by
Using a Sex and Gender Lens. We are pleased to highlight research that provides a deeper understanding of sex-
and gender-based differences that contribute to the epidemic of opioid use disorders. In their literature-based
commentary, Dr. Andrew Koons and colleagues6 emphasize the need to include women in research studies of pain
experience and opioid abuse. The authors caution that most of our knowledge and understanding of the
experience of pain and the factors that lead to opioid abuse have been generated through research dominated by
male animal and human models.7 Their thorough review of recent evidence underscores sex and gender
differences in the experience of pain, rate and risk factors for opioid use disorder, and response to treatment that
can assist health care providers in opioid prescribing stewardship.
Gender Differences in Pain Experience and treatment After Motor Vehicle Collisions: A Secondary Analysis of
the CRASH Study by Dr. Tracy Madsen et al8 reports results of a large multicenter study of emergency
department patients treated for motor vehicle crashes. Madsen and colleagues8 describe gender differences in pain
experiences and treatment with opioids and benzodiazepines on discharge. The gender differences noted can
inform gender-specific interventions to reduce both post-traumatic distress and the risk of developing chronic
pain.
188 Volume 40 Number 2

Editorial
In their study, Sex Differences in Prevalence of Emergency Department Patient Substance Use, Dr. Robert
Cannon and colleagues9 determined the sex-specific prevalence of substance use and misuse in an emergency
department patient population. The understanding that opioids were the second most common substance, after
alcohol, in patients discharged with a substance use disorder allows the ability to explore patient sex in
conjunction with preferred substance use to inform future programs designed at prevention and treatment.
Perception and Practice Among Emergency Medicine Health Care Providers Regarding Discharging Patients
After Opioid Administration by Dr. Ryan Surmaitis and colleagues10 aimed to determine the current attitudes,
perceptions, and practices of emergency providers and registered nurses about the discharge of adult emergency
patients after receiving opioid medications to treat pain. Developing discharge policies or guidelines to ensure
patient safety was an overwhelmingly shared priority of surveyed providers. The use of sex and gender evidence to
inform those future policies will be paramount.
By taking into account the magnitude and rate of rise of the current opioid public health crises, the
identification of these sex- and gender-specific patterns will be crucial to providing new standards of care.
Collectively, this Specialty Update provides strong evidence for sex and gender differences in every aspect of
opioid use and abuse, including motivations for use, treatment needs, and barriers toward effective recovery.
Practicing physicians will now have the opportunity to tailor their treatment of pain and treatment of opioid use
disorders from evidence that highlights clinically relevant sex and gender differences that will benefit both women
and men.
Alyson J. McGregor, MD, MA

Department of Emergency Medicine
Warren Alpert Medical School of Brown University
Providence, Rhode Island
REFERENCES
1. Substance Abuse and Mental Health Services Administration (SAMHSA). Center for Behavioral Health Statistics and Quality.
Results from the 2015 National Survey on Drug Use and Health. Rockville, MD: SAMHSA; September 8, 2016.
2. Salam M. The Opioid Epidemic: A Crisis Years in the Making. New York Times. Published October 26, 2017. https://www.
nytimes.com/2017/10/26/us/opioid-crisis-public-health-emergency.html. Accessed December 11, 2017.
3. American Public Health Association. Prescription Drug Abuse – An American Epidemic. https://www.apha.org/topics-and-
issues/prescription-drug-overdose. Accessed December 11, 2017.
4. Rudd RA, Seth P, David F, Scholl L. Increases in drug and opioid-involved overdose deaths — United States, 2010–2015.
MMWR Morb Mortal Wkly Rep. 2016;65:1445–1452.
5. Hirschfeld J. Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds. The New York Times. https://www.
nytimes.com/2017/10/26/us/politics/trump-opioid-crisis.html. October 26, 2017.
6. Koons A, Greenberg MR, Cannon RD, Beauchamp G. Women and the experience of pain and opioid use disorder: a literature-
based commentary. Clin Ther. 2018;40:190–196.
7. Bodnar R, Kest B. Sex difference in opioid analgesia, hyperalgesia, tolerance and withdrawal: central mechanisms of action and
roles of gonadal hormones. Horm Behav. 2010;58:72–81.
8. Madsen TE, McLean S, Zhai W, et al. Gender differences in pain experience and treatment after motor vehicle collisions: a
secondary analysis of the CRASH study. Clin Ther. 2018;40:204–213.
9. Cannon RD, Beauchamp GA, Roth P, et al. Sex differences in prevalence of emergency department patient substance use.
Clin Ther. 2018;40:197–203.
10. Surmaitis RM, Amaducci A, Henry K, et al. Perception and practice among emergency medicine health care providers regarding
discharging patients after opioid administration. Clin Ther. 2018;40:214–223.
https://doi.org/10.1016/j.clinthera.2018.01.007
February 2018 189

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Clinical Therapeutics/Volume 40, Number 2, 2018

The Opioid Epidemic: Overcoming Challenges by

The opioid epidemic is America’s public health crisis. In 2015, 12.5

188 Volume 40 Number 2

Alyson J. McGregor, MD, MA

February 2018 189

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