The Dangers of Ignoring Mental Health & Addiction History in Prescribing Opiates to Women

According to a CDC report released earlier this month, 6,631 women died of opioid overdoses in 2010, five times more than a decade ago. The rate surpassed the increase seen in men over the same time period.

In a NY Times article about the study, researchers hypothesized that it might be because conditions associated with chronic pain, like fibromyalgia, are more common in women. Women also have lower body mass than men, and more fat tissue, which makes them more sensitive to opioid medications.

The overdose death rate was highest among women ages 45 to 54, which was surprising to clinicians since women in their 20’s and 30’s were more likely to abuse prescription opiates. Many of the women who died were being prescribed combinations of pain medication, addictive anti-anxiety medications (called benzodiazepines), and antidepressants.

The director of the National Institutes of Drug Abuse, Dr. Nora Volkow, said, “Broader social trends, like unemployment, an increase in single-parent families, and their associated stressors, might have also contributed to the increase in abuse, but they are slow moving and unlikely to be a direct explanation.”

This escalation in female deaths is staggering. Although experts attempted to provide myriad reasons as to why so many women were dying, one explanation went unmentioned. Namely, the shocking ignorance with regards to mental health and addiction training, diagnosis and treatment among physicians most likely to prescribe such medications; these include ER doctors, primary care physicians, family practice doctors and even psychiatrists.

Recently, I witnessed this ignorance and cavalier approach to prescribing medication first-hand. While vacationing in Florida, a family member hurt her knee. The ER doctors prescribed prednisone, without mentioning a single side effect or inquiring about psychiatric history. This medication can have severe psychiatric side effects such as worsening depression, mania, etc.  And of course, they provided a prescription opiate for pain—again without asking about substance abuse history. When I asked about an SA assessment, the nurse responded “We can’t do that in Florida — it is against the law.”

Fortunately, I know this family member quite well. I told her to rip up the prednisone prescription, since she has a history of depression and to use the pain meds with caution due to a high risk of addiction.

Subsequently, I wrote a letter to the hospital CEO; after investigating, he said his staff performed adequately. Perhaps, this individual needs to read the statistic mentioned in the first sentence of this blog, and then reconsider if “adequately” is really a reasonable standard.

I do not anticipate seeing this trend change until physicians who prescribe negligently are held accountable. I refer to those who prescribe these addictive medications with impunity, in order to make the “problem” go away, quickly. These professionals do not take the time to know what the problem is, do not conduct even a cursory substance abuse risk screening, and importantly, do not discuss the risks of abuse and dependence with their patients. And the death toll continues to rise.