Sex, gender, and the opioid epidemic: Crucial implications for acute care

Abstract

Introduction: The opioid epidemic continues to escalate in the United States, exacerbated significantly by the COVID-19 pandemic. Necessary steps in acute care medicine to expand efforts to combat this epidemic involve increased emergency department engagement of patients with opioid use disorder (OUD) and an incorporation of evolving sex-and gender-based factors that affect this disease presentation and management course. Methods & Aims: An ever-increasing amount of peer-reviewed, evidence-based literature has shed light on the important biologic and sociocultural variables, specifically sex and gender, which impact OUD trajectory and outcomes. As a collaborative effort of the Sex and Gender in Emergency Medicine (SGEM) Interest Group, a community within the Society for Academic Emergency Medicine (SAEM), we sought to consider, review, and summarize clinically pertinent information as a comprehensive introduction to this topic for the emergency medicine (EM) clinician and educator. Results: A selected overview of current evidence-based data and publications, to include current epidemiologic trends, opioid-based physiology and pathophysiology, as well as opioid use disorder management and outcomes, through a sex-and gender-based lens, was reviewed and included in this summary. Also discussed are implications and recommendations for EM educators seeking insight and resources for continuing, graduate, and/or undergraduate education on this topic. Conclusion: Incorporation of emerging sex-and gender-specific scientific knowledge into clinical context represents a critical link to effective management of the OUD patient in the ED. Similarly, integration of this information into EM education represents an essential step for both sex-and gender-based medicine and opioid-specific training.

Heroin- and Fentanyl-Induced Respiratory Depression in a Rat Plethysmography Model: Potency, Tolerance, and Sex Differences

“…From 2019 to 2020 (during the COVID-19 pandemic), the Center for Disease Control (CDC) reported a 31% increase (up to 28.3 per 100,000) in the age-adjusted rate of overdose deaths, with 75% of those deaths involving an opioid (Death Rate Maps & Graphs | Drug Overdose | CDC Injury Center, 2022). In 2018, the opioid-involved death rate was two to three times higher for men than women (Wilson et al, 2020), which may reflect the higher prevalence of opioid use in men (Walter et al, 2022), however the incidence of opioidinvolved deaths has increased at twice the rate in women (Back et al, 2011). The primary cause of death from opioid overdose is respiratory depression and hypoxia.…”

Emergency-department initiated buprenorphine: Impact on quality of life

“…This relative burden, accompanied by financial strain, (female participants were less likely to be employed or have financial needs met) may result in a sense of depression or ‘no energy for life.’ While historically, men have accounted for the majority of illicit drug use and opioid overdoses, the past decade in particular has seen women increasingly impacted. Gender-specific differences in OUD, as well as OUD treatment outcomes, have been demonstrated previously and deserve continued focus and consideration ( Walter et al., 2022 ). Violence exposure was another subjectively-reported category with disproportionate representation of female participants.…”

Disparities in naloxone prescriptions in a University Hospital during the COVID-19 pandemic

“…Our results also demonstrated the presence of racial disparities as fewer Black people received naloxone prescriptions than whites. Despite being historically and stereotypically considered a disease impacting majority white, male patients in the United States, recent demographic data of people with OUD have shifted to include increasing percentages of women and racial minorities [ 12 , 30 ]. Another study also showed opioid-related deaths among Black people rose 38% from 2018 to 2019 while rates for other racial groups did not significantly change [ 31 ].…”