Sex differences in prescription opioid use

Abstract

Purpose of review Recent literature focused on prescription opioids has neglected gender differences in use. Here we evaluated the recent literature (since 2015) examining gender differences in prescription opioid use. Recent findings Between 2015 and 2016, our review found only eight articles addressing gender differences in prescription opioid use mostly opioid misuse in North America among individuals with chronic pain. Risk factors included depression, pain, and poly-drug use. In addition to that review, we had the opportunity to further address gender differences in, and risk factors for, prescription opioid use through a community engagement program, HealthStreet. Among the sample (n=8,525, Mage = 43.7 years, 58.6% female), approximately half reported use of prescription opioids. Women were significantly more likely to report lifetime use (54.9% vs 42.2%; p <.0001) and report cancer compared to men, yet, women with cancer had a significantly reduced risk of using opioids compared to men with cancer (OR: 0.46; 95% CI, 0.36–0.59). Summary Only a few recently published studies analyzed gender differences related to prescription opioid use. Findings from the literature and our data suggest women are more likely to use prescription opioids compared to men. There is limited information on gender differences in opioid use risk factors and outcomes and more research in this area is warranted.

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

“…2,15 The findings of higher rates among women was similarly noted in a recent study that included 8525 individuals in a community engagement program where 54.9% of women reported lifetime opioid use compared to 42.2% of men. 16 Prior studies evaluating age distribution of prescription opioids noted a predilection for use among middle aged individuals, though our study noted differential rates of use by age group depending on CLD status. 2 Geographic variability is also a consistent theme in the literature, though the specific areas identified to have highest rates of prescription opioid use differ across studies, and the underlying explanation for these differences remain poorly understood.…”

“…Patterns of prescription opioid use by demographic factors have been conflicting across studies . The findings of higher rates among women was similarly noted in a recent study that included 8525 individuals in a community engagement program where 54.9% of women reported lifetime opioid use compared to 42.2% of men . Prior studies evaluating age distribution of prescription opioids noted a predilection for use among middle aged individuals, though our study noted differential rates of use by age group depending on CLD status .…”

Ultrarestrictive Opioid Prescription Protocol for Pain Management After Gynecologic and Abdominal Surgery

“…Prior studies have shown that 2 major factors associated with a high rate of opioid prescriptions at discharge are female sex and moderate to severe pain scores before discharge. 16 Studies investigating the association of sex with pain perception have also shown that women may have higher ratings of pain and lower pain tolerance, hence suggesting that extending the UROPP to male patients would be equally feasible. 17,18 A wide range of complex pelvic and abdominal surgical procedures were performed for our patient population; thus, our results could be applied to other surgical fields.…”

Female rats consume and prefer oxycodone more than males in a chronic two-bottle oral voluntary choice paradigm

“…Prescription opioid abuse liability is increasingly understood as being sex-dependent (Becker and Koob, 2016;Bobzean et al, 2014) , which is supported by the more rapid increase in the rate of prescription opioid abuse in women than men (Warner et al, 2016) . Previous work suggests a role for sex hormones in opioid dependence and opioid reinforcing properties (Alexander et al, 1978;Bobzean et al, 2014;Cicero et al, 2003Cicero et al, , 2002bCicero et al, , 2002cHadaway et al, 1979;Harte-Hargrove et al, 2015;Serdarevic et al, 2017) , particularly in oral self-administration protocols (Stolerman and Kumar, 1972) . Sex differences are also apparent in the pharmacokinetic, metabolic, and analgesic effects of oxycodone (Chan et al, 2008;Holtman and Wala, 2006;Neelakantan et al, 2015) , and subtle differences have been observed in the liability for opioid abuse (Collins et al, 2016;Mavrikaki et al, 2017) .…”

“…Sex differences are also apparent in the pharmacokinetic, metabolic, and analgesic effects of oxycodone (Chan et al, 2008;Holtman and Wala, 2006;Neelakantan et al, 2015) , and subtle differences have been observed in the liability for opioid abuse (Collins et al, 2016;Mavrikaki et al, 2017) . Therefore animal studies show that, relative to males, females self-administer more opioids, are more vulnerable to their reinforcing effects, and become more physically dependent, (Alexander et al, 1978;Boyer et al, 1998;Cicero et al, 2003Cicero et al, , 2002aGraziani and Nisticò, 2016b;Hadaway et al, 1979;Lofwall et al, 2012;Lynch, 2018;Lynch et al, 2002;Serdarevic et al, 2017) . In our work presented here, when rats were given a choice between a water bottle and an oxycodone-containing bottle, both sexes readily drank oxycodone and escalated their intake, but females self-administered twice as much oxycodone by body weight as did males, with a resultant five-fold increase in blood levels.…”