Written by Katie Pallett-Wiesel, edited by Charlie Gagnon

Featured image: Photo by Patrick Tomasso on Unsplash

While many of us have spent the years since 2020 focusing on the pandemic, it is crucial that we turn our attention to the deadly opioid epidemic facing Canada. Opioid related deaths have been on the rise in Canada since 2010, with the COVID pandemic exacerbating existing issues. In British Columbia, between January 2020 and July 2021, 3,000 people died due to drug overdoses, while 1,800 died from COVID during that same period. Deaths due to fatal drug overdoses in Ontario have increased 25% following the pandemic in 2020. In the discourse surrounding this epidemic, one crucial theme is missing from the research, conversation, and policy implementations: the gendered impacts of the opioid crisis on women. 

Since the implementation of opioids into clinical practice in the 20th century, women have been prescribed these drugs at higher rates than men for the treatment of so-called “female ailments”, such as painful menstruation and “hysteria”. To this day, women possess a unique set of risk factors that make them more likely to be prescribed opioid medications at higher doses than men, and for longer periods of time. For instance, women are more likely to experience chronic pain, potentially due to chronic pain conditions or their reproductive capacity. In addition, women may have biological tendencies that make them more likely to become dependent on prescription pain meds at quicker rates than men, such as difference in sex hormones and average body composition. 

While women make more frequent visits to healthcare providers, they are less likely than men to be assessed for substance use and misuse. Part of the tendency to overlook women’s risk of addiction, despite the available risk factors, could be due to the gender norms that prevent doctors from associating drug addiction to femininity. 

In addition to being more likely to become dependent on opioids through a prescriber, women are affected by interconnected environmental factors that render them more vulnerable to opioid overdose and death. Women who engage in opioid use were found to experience more physical and psychological difficulties than male users, along with an increased likelihood of unemployment. Marginalized women, such as women that have previous criminal justice involvement, housing instability, social isolation, and indigenous status, experience high mortality rates that are often ignored. Mortality rates due to overdose among previously incarcerated populations are much higher, which could be a result of tolerance change following incarceration, as well as the criminalization of opioids and the surrounding stigma associated with opioid use which is exacerbated by increasing criminalization. The issue of housing is a driver of opioid use–the stigma around homelessness, economic barriers, and the lack of social network push homeless people to use opioids alone, thus increasing the risk.. In Vancouver, the opioid crisis and the housing crisis are closely intertwined, with drug use being concentrated in a single area of the city with high poverty and unavailability of housing. In addition, police discrimination against indigenous populations in Canada exacerbates tensions with opioid criminalization, criminal justice involvement, and overdose risks. These vulnerable communities face a higher risk of overdose, and therefore have a higher need for access to naloxone, a lifesaving medication for opioid overdose. 

On top of being at higher risk for opioid use, women face barriers that prevent them from engaging in harm reduction measures, and from receiving treatment. Overdose prevention sites remain masculinized spaces, jeopardizing women’s access, and sometimes safety, in making use of this resource. However, overdose isn’t the only risk women face when engaging in opioid drug use, as drug users in public spaces also run the risk of sexual assault, theft, and gendered violence. This can cause women to opt to use alone, despite the increased overdose risk. This is especially true for indigenous women, who are more likely to choose to use alone to mitigate risks of racism and gendered violence. This can partially explain the disproportionate overdose deaths in populations of indigenous women compared to non-indigenous women. Involuntary disclosures among women have also been associated with increased risk of violence, damage to social relationships, and harm to economic opportunities, producing additional barriers to engaging in harm reduction resources that may lead to involuntary disclosures. 

Women may also take extra measures to avoid physical manifestations of drug, such as physical markers on the body, which could lead to involuntary drug disclosures. This has been shown to negatively impact their social relationships, increase their risk of violence, and damage their economic opportunities. The result: women are compelled to inject in less visible areas, leading, in some cases, to a heightened risk of overdose. There are also gendered injecting dynamics at play which put women physically at risk, such as women being second to use the needle, putting them at a higher risk of blood-borne infections, and drug use controlled by male partners, giving women less autonomy over their bodies. 

Another notable gender difference in opioid use is related to the number of suicides by overdose; a study conducted in Ontario found that  9% of fatal overdoses among men were ruled suicides while 52% of fatal overdoses in women were deemed suicides. This suggests that policies must be tailored to address the specific needs of women in preventing overdose. While part of this may be explained by higher prevalence of drug-related suicide among women, it also speaks to the motives and impacts of women’s use of opioids. 

While drug use is gendered, policies and clinical practices aimed at dealing with this problem, as well as research into the crisis, have largely been absent. In order to address this problem and the unique needs of women, especially those of marginalized identities, up-to-date research on Canadian women and opioid use is imperative. In particular, research into women experiencing factors that increase their risk (lack of access to housing, lack of social network, economic difficulties) is urgently necessary to prevent additional deaths.