The US Approach to the Overdose Crisis is Failing Women

The overdose crisis continues to ravage the United States, but its egregious, multi-faceted impact upon women is not getting the attention it deserves.

In January 2019, the Centres for Disease Control and Prevention (CDC) published staggering data: 18,110 women aged 30-64 died in the US following drug overdoses in 2017, a 260 per cent increase since 1999.

While the CDC noted that the increase could partly be attributed to “increases in certain drug combinations” being used, the majority of deaths were attributable to opioids. The largest rises in deaths during this 19-year period include those involving synthetic opioids (1,643 per cent increase) and heroin (915 per cent increase).

While many of these deaths were accidental, medical officials have expressed concern that some were deliberate suicides – and that the lack of evidence for this is hiding a growing mental health crisis in the country.

Dr. Michael Lynch, director of the Pittsburgh Poison Center at the Pittsburgh Medical centre, said:

"Most likely there are hidden suicides here. It can be very difficult to tell. As we know from post-mortem evaluation, a determination is made whether it was intentional or not. But of course, rarely do we know the individual's mind-set before these tragic events. Sometimes there are clear indicators like suicide notes. And sometimes unfortunately, people have died, and we find a fatal amount or combination of drugs in their system, but we don't know how or why they got there. I'm sure there's a lot of overlap between misuse and unintentional overdose and those who intentionally overdose to kill themselves."

This suggests that there are multiple factors leading to overdose deaths among women that are being insufficiently addressed by authorities. Additionally, specific issues faced by women who use drugs are often neglected by the media; press coverage of the overdose crisis is often male-oriented.

"The stereotype is a man who's addicted to drugs who's ODing on the street, and we know that that stereotype is clearly not complete. It's inaccurate," said Dr. Georges Benjamin, executive director of the American Public Health Association. "Women's part of the issue is just being not portrayed and not understood by most people."

A 2018 Guardian investigation into the experiences of women "battling addiction" in a Tennessee county jail found inmates caught in a vicious cycle; ending up in and out of prison due to low-level drug offences, unable to treat their drug dependency because of a lack of resources or support from the state. While incarcerated, they are confined to their cell with other women enduring withdrawal symptoms, and with no counselling.

Michelle Leopard, 38, who was using drugs before being incarcerated at Campbell County jail in Tennessee, decried this lack of support: “Down here there is no kind of resources for women to get the help they need”, she said, “[I am] always scared about ending up back in jail.”

It is essential that women in this particular age group are heard, and that their concerns are taken seriously; if not, the number of deaths will only grow.

Increased access to state-sponsored or affordable mental healthcare is imperative, but when such approaches fail, it is equally vital for the state to avoid focussing on abstinence or incarceration to “treat” people with drug dependency. The criminalisation of drug possession dissuades people from seeking help for their drug use, and can particularly discourage women – who may be the sole caregivers to children and therefore fear having their kids taken away by authorities.

The US should involve women who use drugs as stakeholders in the conversation around treatment, and ascertain gender-specific approaches that can reduce the harms of the overdose crisis on this demographic. Most urgently, women who use drugs in the US must feel comfortable to have open and honest conversations about their drug use without shame or judgement.