Sex differences in drug use among polysubstance users

Abstract

Background Available evidence indicates women with substance use disorders may experience more rapid progression through usage milestones (telescoping). The few investigations of sex differences in treatment-seeking populations often focus on single substances and typically do not account for significant polysubstance abuse. The current study examined sex differences in a heterogeneous sample of treatment seeking polysubstance users. We examined patterns of drug use, age at drug use milestones (e.g., initial use, regular use), and progression rates between milestones. Nicotine and alcohol use were also evaluated. Methods Participants (N=543; 288 women) completed personal histories of substance use, including chronicity, frequency, and regularity, as well as inventories assessing affect, and intellectual ability. Results Rates of drug use and milestone ages varied by sex and specific drug. Analyses suggested pronounced telescoping effects for pain medication and marijuana, with women progressing more rapidly through usage milestones. Conclusions Our data were generally supportive of telescoping effects, although considerable variance in progression measures was noted. The contrast between the marked telescoping observed in pain medication use and the absence of telescoping in other opioids was of particular interest. The discrepancy in telescoping effects, despite shared pharmacologies, suggests the need for further work examining underlying psychosocial factors. These results highlight that the specific sample population, substance, and outcome measure should be carefully considered when interpreting sex differences in substance use.

Evidence for Sex Convergence in Prevalence of Cannabis Use: A Systematic Review and Meta-Regression

“…Regardless of the explanations for these shifts, given evidence that cannabis use in women is associated with a faster progression to cannabis use disorder (Lewis et al, 2014) as well as greater risk for comorbid anxiety and depression during adolescence (Kloos et al, 2009), the findings raise concerns about the potential for increased cannabis-related harms among young women. Further, given that recent reviews have suggested that greater female vulnerability to cannabis use disorder may be linked to important biological differences such as neuronal maturation over adolescence, sex-specific responses to cannabinoid compounds, and hormone and cannabinoid receptor interactions (Kuhn, 2015;Rubino & Parolaro, 2015), increased cannabis use among adolescent females is of particular concern.…”

“…Furthermore, several studies have suggested that women who use cannabis are more vulnerable than men to the development of cannabis use disorder, particularly during adolescence (Kuhn, 2015) and that, following first use, they progress more quickly than men through the cannabis-related problems cycle (Lewis et al, 2014). Substantial changes over time in the sex distribution of cannabis use may require a rethink of effective prevention, public health, and intervention strategies to combat the harms and costs associated with cannabis use.…”

Reentry programming for opioid and opiate involved female offenders: Findings from a mixed methods evaluation

“…Evidence also indicates that men and women differ in drug use initiation, relapse, and drug choice with women more likely to abuse prescription drugs than illicit substances (Fattore, Melis, Fadda, & Fratta, 2014). Women become immersed in serious drug use faster than do men (Bloom, Owen, Covington, & Raeder, 2003;Fattore et al, 2014;Lewis, Hoffman, & Nixon, 2014) and experience more rapid progression through drug use milestones (e.g., initial use, regular use, chronic use), particularly for pain medication and cannabis (Lewis et al, 2014).…”

“…Other researchers have gone so far as to call for specific gender-responsive criminal justice policy (Bloom et al, 2004). Past research has also emphasized understanding potential differences in the needs and recovery processes of drug dependent male and female offenders to design optimal interventions (Anglin, Hser, & Booth, 1987;Lewis et al, 2014;Messina et al, 2006). Because women experience different, often gendered, pathways to drug abuse, crime, and desistance, reentry programming should ideally reflect these particular needs (e.g., trauma informed care, parenting issues, social support).…”

Gonadal hormones do not alter the development of antinociceptive tolerance to delta-9-tetrahydrocannabinol in adult rats

“…Furthermore, in the first study the tolerance-inducing dose was adjusted for sex differences in acute potency of THC, such that females received approximately 30% less THC than males did during the chronic treatment period, yet THC potency still decreased more in females than males. Epidemiological evidence indicates that women are more susceptible than men to rapid development of abuse and dependence on a variety of addictive substances, including marijuana (Khan et al, 2013; Lewis et al, 2014), and women are more likely than men to report physical withdrawal symptoms upon cessation of chronic cannabis use (Copersino et al, 2010). Given the significant role of drug tolerance in the development of substance abuse and dependence, females’ greater potential for developing cannabinoid tolerance may contribute to female cannabinoid users’ more rapid trajectory to abuse and dependence.…”