Many women who experience violence and other traumatizing situations use opioids to self-medicate, an expert suggests.
Gender-based domestic violence plays a role in the opioid epidemic—as it relates to why women use opioids, when they access treatment, and how they are treated during overdose emergencies.
Writing for The Conversation, Nabila El-Bassel, professor of social work at Columbia University, said that just like women were at increased risk during the HIV epidemic because of domestic partner violence, they are at increased risk for opioid misuse today.
El-Bassel shared the story of Tonya, who used heroin when she anticipated being abused by her boyfriend.
“Tonya is only one of the hundreds of women I’ve interviewed for my research with similar stories in the span of my nearly 30-year career studying the links between intimate partner violence, sexual coercion, substance use disorders and HIV,” El-Bassel writes.
Many women who experience violence and other traumatizing situations use opioids as a way to self-medicate, just as Tonya did. Women who deal regularly with domestic violence often use opioids as a way to help control their emotional pain.
“Treatment must address the need for escape that these women seek,” El-Bassel writes.
Yet, many women in abusive relationships have trouble accessing treatment. Partners—especially those contending with substance abuse themselves—will often undermine a woman’s attempt to get sober. This becomes yet another way that abusive partners exert dominance over the women in their lives.
“They can control their ability to engage in treatment, deny them potential sources of protection, and jeopardize the custody of their children to maintain control over them and, for some men, have women take care of them,” El-Bassel writes.
Women who are in abusive relationships often don’t feel that they can protect themselves by demanding safe sex or clean needles. Oftentimes, their partners don’t give them a choice in the matter. Because of this, harm-reduction strategies like needle exchange fail to help the most vulnerable, El-Bassel writes.
“Studies have shown that women are often physically or sexually abused when negotiating safe sex or refusing to engage in drug risk,” she said.
Alarmingly, it’s not just intimate partners who put women at higher risk for opioid abuse. Systematic gender biases also affect access to treatment, El-Bassel writes. She points to a recent study that found that women are three times less likely than men to be treated with naloxone during an overdose.
This “is likely due to their being devalued,” El-Bassel writes. “Emergency responders and police officers as well as family members and peers must be trained to overcome this gendered barrier and recognize signs and symptoms of overdose.”
Overall, the treatment community needs to do a better job of understanding risk factors unique to women and providing interventions that work for this population, El-Bassel says.
“These issues must be changed if we are serious on addressing the opioid epidemic among women,” she writes.
