WOMEN AND PRESCRIPTION AND ILLEGAL DRUGS
Under the influence of the drug, the woman loses control of herself… When she acquires the habit, she does not know what lies before her; later, she does not care. She is a young woman who is years upon years old.
--Judge Emily Murphy, 1922
· More than 7.5 million girls and women a year misuse or abuse prescription drugs.
· Women are up to 48 percent more likely than men to be prescribed a narcotic, antianxiety, or other potentially abusable drug.
· Women who use sedatives, antianxiety drugs, or hypnotics are almost twice as likely as men to become addicted to these drugs.
· Teenage girls are more likely than teenage boys to use prescription drugs for non-medical reasons.
· More than half of American women between the ages of 18 and 25 have used illicit drugs at least once in their lives.
· More than 2.5 million women abuse or are dependent on illicit drugs.
· Two out of three AIDS cases in American women are associated with drug abuse.
Illicit Drugs of Choice
Marijuana is, by far, the most commonly used illicit drug in the United States. The main chemical component of marijuana, THC, produces sedation, mild euphoria, and mild analgesia and in high doses may intensify sensations or cause hallucinations. The marijuana used today is more than twice as strong as it was in the late 1970s and early 1980s. Smoking marijuana during early adolescence increases the risk of anxiety and depression in late adolescence, particularly for girls and young women. Long-term use of marijuana can lead to psychological addiction, with withdrawal symptoms that include anxiety, irritability, and insomnia. Chronic marijuana smoking also can lead to many of the same respiratory problems as tobacco smoking, including cough and phlegm, symptoms of chronic bronchitis, frequent chest colds, and several forms of cancer. Prolonged use of marijuana can lead to serious lung disease. Marijuana use also can impair attention and short-term memory and distort perception and judgment.
Cocaine commonly is snorted, injected, eaten, or smoked as free-base or crack cocaine. Crack cocaine is made by combining cocaine with ammonia or baking soda. When heated, it produces the crackling sound that gives it its name. While cocaine is highly addictive, crack cocaine is even more so. Women become addicted more quickly to crack cocaine than men even when they are casual or occasional users. Cocaine use increases heart rate, breathing rate, blood pressure, and body temperature. It can cause heart attack, heart aneurysm, or stroke. Women appear to be more sensitive to the cardiovascular effects of cocaine than men. Its long-term use can affect a woman's reproductive system, resulting in problems with ovulation and miscarriage.
Heroin is a highly addictive drug. Injected, snorted, or smoked, it initially causes euphoria followed by periods of drowsiness and wakefulness and mental confusion. It can slow breathing to the point of respiratory failure and cause pneumonia and other pulmonary disorders. Long-term use can lead to collapsed veins, abscesses, heart infections, and liver disease. Sudden withdrawal from heroin can cause vomiting, diarrhea, insomnia, muscle and bone pain, and cold flashes, but rarely death. Withdrawal symptoms--which peak after a few days--can last up to a week. Heroin overdose can result in shallow breathing, convulsions, coma, and death.
The term inhalants comprises a wide variety of substances, normally easily obtainable, whose vapors can be inhaled to produce a mind-altering effect. Such substances include paint-thinners; gasoline; felt-tip marker fluids; aerosol sprays, such as spray paint, hair spray, and cooking spray; and gases from whipped cream canisters and butane lighters. Consequences of inhalant use can be deadly and sometimes immediate: "sudden sniffing death" occurs when prolonged sniffing, particularly of butane or other gases, results in heart failure within minutes. Death can result when inhaled chemicals force the air out of the lungs, resulting in asphyxiation. Long-term use of inhalants can result in severe and irreversible brain damage, producing symptoms similar to those of multiple sclerosis. Severe dementia and inability to coordinate movement are possible. Chronic use also results in damage to the heart, lungs, liver, and kidneys.
Ecstasy (MDMA) acts both as a stimulant and a hallucinogen. Ecstasy affects serotonin in the brain, which in turn can affect sleep, mood, appetite, sexual behavior, and memory. Heavy Ecstasy users are at risk of hyperthermia, dehydration, and heart or kidney failure. Chronic, heavy use increases the risk of sleep disorders and may increase the risk of memory- and attention-related deficits. Women appear to be more susceptible than men to the toxic effects of heavy Ecstasy use on the brain.
Methamphetamines are powerful stimulants that can be swallowed, smoked, snorted, or injected. Their effects on the brain are similar to the effects of cocaine; they stimulate the release of high levels of dopamine and produce euphoria. Methamphetamines--which are highly addictive--can cause wakefulness, increased physical activity, anxiety, and paranoia. They can cause heart attack, stroke, and Parkinsons-like symptoms. Overdosing can lead to hyperthermia, convulsion, and death. Because they suppress appetite, methamphetamines appeal to girls and women who want to lose weight.
Drug-related violence has become increasingly common on college campuses because of the recent popularity of certain club drugs, some of which are called "date rape drugs." The most common of these drugs are GHB (liquid ecstasy), Rohypnol (roofies), and ketamine (K or Special K). Because date-rape drugs are odorless, flavorless, and colorless, they easily can be slipped into a drink. When combined with alcohol, these drugs can cause incapacitation or unconsciousness, and if a woman is sexually assaulted, she may be unable to recall exactly what happened to her.
Prescription Drugs of Choice
Commonly abused painkillers, also known as opioids, narcotics, or analgesics--such as morphine, codeine, OxyContin, Vicodin, Darvon, and Demerol--are highly addictive. A large single dose of certain painkillers can severely depress the respiratory system and even lead to death. Sudden withdrawal from these drugs can lead to violent shaking, bone and muscle pain, diarrhea, and vomiting.
Tranquilizers and sedatives fall under the heading of CNS (central nervous system) depressants. Often referred to on the street as "downers" or "chill pills," these drugs commonly are prescribed to relieve anxiety, quell panic attacks, and promote sleep. CNS depressants are addicting, and their long-term use results in tolerance, such that larger doses of the drug are needed to achieve its effects. If use of these drugs is discontinued abruptly, serious withdrawal symptoms, including seizures, can result.
Also referred to as "speed" and "uppers," stimulants such as amphetamines enhance brain activity, producing increased alertness, attention, and energy as well as elevated blood pressure and increased heart rate and respiration. Amphetamines and other stimulants can result in side effects, including insomnia, irritability, dizziness, adverse mood reactions, and loss of appetite. Stimulant users sometimes attempt to counter these effects by using other drugs, such as CNS depressants or opioids. As a result, individuals who continually use stimulants are at a greater risk for developing multiple drug dependencies.
Anabolic steroids are hormones derived from the male sex hormone, testosterone. Injected, taken orally, or rubbed into the skin, they are normally used to relieve pain and rebuild muscles from physical injury. They also are used to treat delayed puberty and treat some other hormonally related conditions. Misuse of steroids can retard bone growth; damage the liver, heart, and kidneys; increase blood pressure and bad cholesterol; and cause severe acne. Because they are sex hormones, they can cause growth of facial hair, baldness, clitoral enlargement, menstrual changes, and a deepening of the voice in girls and women. Misuse of steroids also can cause extreme mood swings, aggression, and even violence. Because steroids can cause fat loss and lean muscle gain, some girls use them to achieve shapeliness and to control weight. Some also use them to help reduce their breast size.
Over-the-Counter (OTC) Abusable Drugs
OTC Stimulants - These amphetamine-like drugs usually contain caffeine and/or phenylpropanolamine and are promoted as appetite suppressants or stay-awake drugs. The use of these drugs is especially high among high school students who also use illicit drugs. When taken in high doses, these drugs can cause an amphetamine-like high and side effects such as restlessness, insomnia, irritability, weight loss, flushed skin, and dilated pupils.
The use of diet pills, some of which are stimulants, is dramatically higher among girls than boys; almost one out of four senior girls has used them at some point, compared with fewer than one in ten boys. Girls and women with eating disorders often abuse diet pills as well as diuretics, emetics, and laxatives, which contribute to weight reduction by inducing vomiting, diarrhea, or water loss.
Other over-the-counter drugs containing nicotine and alcohol are likely candidates for misuse and abuse. For example, some teens, including some nonsmokers, misuse OTC nicotine patches, gum, and other products; of those teens who use nicotine replacement products, 18 percent are nonsmokers. Cough medicines, including some cold medications, often contain alcohol--as much as 40 percent--and may be abused. In the past, a cough medicine might have contained both alcohol and codeine. While codeine is no longer available in OTC medications, its predecessor, dextromethophan (DXM--often labeled DM, Tuss or Maximum Strength), can cause hallucinations and other psychedelic effects when taken in large dosages. Today, cold medications such as Robitussin, Benadryl, NyQuil, and Coricidin are the latest additions to a growing list of OTC drugs that teens abuse to get high, a practice sometimes referred to as "robotripping."
Drugs Commonly Prescribed to Women in the Eighteenth and Nineteenth Centuries
Opium Produced from the seeds of the Asian poppy, this drug was prescribed to women and babies for a variety of health problems, including melancholia and neurasthenia.
Laudanum A mixture of alcohol and tincture of opium commonly prescribed for "women's problems" and also given to soldiers during the Civil War.
Morphine Derived from opium and first produced commercially in 1827, it was used as a pain reliever and cure for "women's problems" and alcoholism.
Codeine Derived from opium. Until the early 1980s, codeine was an active ingredient in most over-the-counter cough medicines.
Cannabis Widely prescribed from 1840 to 1900 for gonorrhea, headache, labor pains, postpartum depression, and various other "women's problems."
Cocaine Introduced in the United States in 1876 and used often as a treatment for alcohol and opiate addiction as well as neurasthenia. Cocaine was a major ingredient in Coca-Cola and many other drinks and tonics.
Sources: Aldrich, M. R. (1994). Historical notes on women addicts. Journal of Psychoactive Drugs 26(1):61-64; Sandmaier, M. (1992). The Invisible Alcoholics: Women and alcohol (2nd ed.). Blue Ridge Summit, PA: TAB Books. University of Buffalo, Addiction Research Unit. (2001). Before prohibition: Images from the preprohibition era when many psychotropic substances were legally available in America and Europe. http://wings.buffalo.edu/aru (accessed March 4, 2004). Kandall, S. R. (1998). The history of drug abuse and women in the United States. In Wetherington, C. L., and Roman, A. B., Drug addiction research and the health of women: Executive summary (NIH publication no. 98-4289) (8-16). Rockville, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.
Overprescribing to Women
Women in the late 1960s accounted for:
- 53 percent of the adult population
- 59 percent of all visits to doctors
- 63 percent of all barbiturates prescribed
- 66 percent of all nonbarbiturates, sedatives, and hypnotics prescribed
- 68 percent of all antianxiety drugs prescribed
- 71 percent of all antidepressants prescribed
- 80 percent of all amphetamines prescribed
Source: Brecher, E. M., and Editors of Consumer Reports Magazine. (1972). Consumers Union report on licit and illicit drugs. www.druglibrary.org (accessed December 28, 2001).
Questions Physicians Can Ask Their Older Female Patients to Screen for Prescription Drug Abuse
· Do you see more than one health care provider regularly? Why?
- Have you switched doctors recently? Why?
- What prescription drugs are you taking? Are you having any problems with them?
- Where do you get your prescriptions filled? Do you go to more than one pharmacy?
- Do you use any nonprescription medications? If so, which, why, how much, how often, and how long?