Our expert is Mishka Terplan, MD, MPH, FACOG, FASAM, Professor, Departments of Obstetrics and Gynecology and Psychiatry, Virginia Commonwealth University School of Medicine

If there is a medical topic you would like to see explored here, please let me know!

Very best,

Mitzi Perdue

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WE ARE CURRENTLY EXPERIENCING A THIRD U.S. OPIOID EPIDEMIC

There have been two other opioid epidemics in the United States. This means we have considerable knowledge and experience with how to treat individuals with addiction. The first major epidemic began before 1900. During this period, women were often prescribed a tincture of opium or morphine to relieve “female ailments” such as menstrual discomfort or hysteria. The next epidemic was in the 1970s, and during this period, 80% of heroin users were men. Today, women are using more than men.

THE CURRENT OPIOID EPIDEMIC AFFECTS WOMEN DISPROPORTIONATELY

The 2015 National Survey of Drug Use and Health (NSDUH) shows that women are initiating opioid misuse at greater rates than men. New female users initiate their use at the rate of 3300 a day. There are things, both biological and social, somewhat unique to women which make them susceptible to addiction. Biologically, individuals with a uterus may seek pain relief because of menstrual pain or other hormonally-related issues. Socially, in our society, women are more likely to have experienced childhood sexual or physical abuse or be in a current or recent violent relationship and this correlates with increased susceptibility to misuse. For women who inject drugs, their first experience is often their male partner injecting them, so it can be a replication of a relationship in which power and control play a major role.

WHAT THE HEALTH CARE PROVIDER CAN DO TO PREVENT MISUSE

Ideally, the clinician should prevent addiction before it starts. Prescribe opioids sparingly and do not prescribe them for chronic pain. Don’t give large prescriptions where others in the patient’s home can get at them. Make sure that unused opioids get disposed of. There are take-back days organized locally as well as safe disposal kits that families can get. We know a little about how to prevent addiction; we know a lot about how to treat it; but we don’t know how to cure it. For individuals with addiction – they need treatment – which includes both medication and behavioral counseling. Addiction in some ways resembles cancer. As with cancer, some may become cured, but for many it’s a chronic condition for the rest of their lives. Even though individuals can experience remission, the underlying problem may recur and it may eventually take their lives.

SCREEN TO PREVENT POTENTIAL MISUSE

Screen for risk of misuse before prescribing opioids. Ideally, screening happens on the patient’s first visit. Several sets of screening questions are available that have been validated and found to be accurate. You can find information on the following opioid risk assessment screens at: http://www.opioidrisk.com

Opioid Risk Tool (ORT)
D.I.R.E. Score, and Screener
Opioid Assessment for Patients with Pain-Revised (SOAPP-R)

DEVELOP A NON-JUDGMENTAL THERAPEUTIC RELATIONSHIP WITH THOSE WHO ALREADY HAVE MISUSE DISORDER

People with opioid misuse disorder are usually well-aware that their addiction is damaging to: their work; their bodies; their social relationships; and the rest of their lives. There’s also shame and guilt around addiction, particularly if the woman is pregnant. Let your patient know that you’re there to help and you’re not going to call the cops. If you provide a clinical space that is safe and welcoming, and if you treat people with respect and dignity, you will be able to foster the needed therapeutic alliance.

REMEMBER THE HUMANITY OF YOUR PATIENT WHO MISUSES DRUGS

She has the same sets of motivations and desires as everyone else. She wants to live an existence that makes sense and that’s connected with others. However, because of her substance use disorder, she may find herself being moved farther and farther from the center of society. She may feel that the only avenue to be accepted back into the human family is through motherhood. This is a positive and we need to embrace this. Policies that punish pregnant women for drug misuse are not going to work. We need to help these individuals regain their lives.