Point of View

A centuries-old pattern in drug abuse by women

July 19, 2013 

A recent study by the Centers for Disease Control and Prevention reported that fatalities due to prescription painkillers increased fivefold among women from 1999 to 2010, an alarming rate increase far surpassing that seen in men. Both the statement made by the director of the CDC that fatalities of this type in women are “underrecognized” and by a New York Times reporter that “prescription pain pill addiction was originally seen as a man’s problem” show how little we have learned from our own national history.

In fact, women have made up the majority of prescription pill addicts in the United States since the 19th century. Epidemiologic reports, however primitive, estimated that women made up 65 percent and 75 percent of the country’s opium addicts. During that early period, women frequently became addicted through self-medication, use of proprietary or “patent” medicines (until the Pure Food and Drug Act in 1906) or with the collusion of physicians and pharmacists, who were overzealous, ignorant, condescending or greedy.

Women were medicated excessively for organic complaints, especially “female problems,” but also for vague nonorganic complaints called “neurasthenia” or “nervous weakness.” In the Victorian Era, women were thought to require “special protection” and considered less able to bear physical and psychic discomfort. It is hardly surprising that, even then, female drug addiction constituted an epidemic of great but unacknowledged proportions.

By the 1920s the demographics of drug use had shifted so that urban minority males began to dominate the drug landscape. It was not generally recognized, however, that female drug users continued to constitute about 30 percent of America’s addicts, a figure which has remained relatively stable. One particular spike in female addiction (and particularly relevant to the CDC study) occurred during the 1950s and 1960s, with the development and pharmaceutical company promotion of hypnotics, stimulants, sedatives, minor tranquilizers and antidepressants.

A California study in 1967 found that women were twice as likely to be treated with psychotropic medications as were men. By the late 1960s, national data showed that women made up two-thirds of all psychoactive prescription drug users and three-quarters of antidepressant users.

It is interesting to note the reasons provided by men and women to explain why women have always made up the majority of prescription drug users. Today, just as in the mid-19th and early 20th centuries, men tend to ascribe this pattern to physiologic and pharmacologic differences between the sexes and say that women are “more likely to have chronic pain.” Women, on the other hand, tend to explain their drug dependence on societal pressures (competition in a male-dominated society, single parenting responsibilities), a need for numbness to deal with these pressures and the seeking of drug-induced highs from feelings of “prettiness, strength and productiveness.”

Although the reasons behind debilitating and often fatal drug abuse in women are varied, this problem has always spanned all levels of society. In the 19th and early 20th century, female addicts were found from the highest levels of society down through the working class to the downtrodden, many of whom were prostitutes and petty criminals. In the 1960s psychotropic medication overuse was particularly prevalent among the middle class and students.

The current CDC study found the highest rates of drug overdoses in the age group 45-54 and in the Native American and white populations.

More than 160 years have passed since our first national epidemic of prescription drug abuse in women. The consistency of this demographic observation has not changed with time, yet we still seem surprised with each new variation of this pattern. The CDC report re-emphasizes what by now we should have already learned: Doctors need a “mindset change” in realizing that prescription drug addiction is not a “man’s disease” but rather a problem that has affected both sexes but has disproportionately created havoc in the lives of women.

Stephen R. Kandall, M.D., of Raleigh served as chief of neonatology at Beth Israel Medical Center from 1976 to 1998 and retired in 1998 as professor of Pediatrics at the Albert Einstein College of Medicine.

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