Overdose deaths from prescription painkillers rose much faster among women than men over the last decade, according to a new federal study that highlights the epidemic's shrinking gender gap.
Men are still more likely to die of overdoses from painkillers, but women — particularly middle-aged women — are catching up at a startling pace. Between 1999 and 2010, deaths rose more than 400 percent among women, compared with 265 percent among men, the U.S. Centers for Disease Control and Prevention said in the study released Tuesday.
"Prescribing an opioid may be condemning a patient to a lifelong addiction," CDC director Tom Frieden said Tuesday. "Unfortunately, women are catching up in this regard."
While the reasons aren't entirely clear, CDC officials said opioid drugs — such as hydrocodone and oxycodone — have been prescribed by physicians far more often in recent years. Once regarded as solely for cancer patients, the highly addictive drugs have come to be given for everything from arthritis to back pain, a development many blame on pharmaceutical marketing.
More than 10,000 men died of painkiller overdoses in 2010, compared with more than 6,600 women, a disparity often attributed to men's greater rates of workplace injuries and risk-taking behavior. But studies have shown women are more likely than men to be prescribed opioid pain relievers, to shop for doctors who'll prescribe them, and to use them on a long-term basis. Yet they may be more biologically susceptible to harm from the drugs.
Florida does not track prescription drug overdoses by gender, only by age. "We were so focused on the big numbers of seven and eight people dying every day that we didn't particularly break it down by gender," said Bruce Grant, who served as director of the now-defunct Governor's Office of Drug Control. Though 2010 is the most recent year for which national numbers are available, newer state figures indicate overall drug deaths have declined. It's not known whether that's true among both sexes.
Evidence of painkillers abuse among women is clear. More than 1,500 Florida babies are born each year already addicted to painkillers, prompting a public awareness campaign that urges pregnant women to discuss painkiller use with their doctors even if they are taking the drugs illegally.
In Pinellas County, Judge Dee Anna Farnell even created a "Ladies Day'' in drug court to address the many women showing up with drug problems, especially with prescription drugs.
Women, especially in middle age, tend to suffer disproportionately from chronic pain conditions, said Roger Fillingim, director of the Pain Research and Intervention Center of Excellence at the University of Florida.
They are six times more likely than men to suffer from fibromyalgia, for instance, and nearly three times as likely to suffer migraines, he said. They are more likely in older age to suffer from osteoarthritis, and they are also more likely in surveys to acknowledge chronic pain.
They may be more likely to seek help for pain and to suffer from mental health disorders, including depression, that can make pain worse, noted Tampa rheumatologist Edgard Janer.
Not all pain conditions should be treated with opioid painkillers, whose long-term effectiveness has not been proved, said Bob Twillman, director of policy and advocacy at the American Academy of Pain Management. Opioids can worsen migraines, for instance, he said.
Twillman said the CDC report raises an important issue but can offer only theories.
"The trouble with this report is that there's a problem, but it doesn't tell us why it exists," he said, noting that the CDC did not break down whether the deaths resulted from combining painkillers with other drugs. "This is a signal that says something is wrong, but we have to figure out what the mechanism is."
David Craig, a clinical pharmacologist who works with palliative care patients at Moffitt Cancer Center, said women's bodies may have a lower tolerance to the drugs, putting them at greater risk for accidental overdoses. In addition, women are more likely to take anti-anxiety drugs, such as Xanax, which can intensify the effect of painkillers.
The greatest increases in overdose deaths were in women ages 45 through 64. Craig said women at that age may have been taking the painkillers for years and may need higher, possibly risky, doses to overcome tolerance.
Dr. Sunil Panchal, a former University of South Florida medical professor, said the report is more evidence that, despite all the publicity about painkiller addiction, too many doctors and patients fail to consider the drugs' safety when used for years to treat chronic pain.
"No one has had a specific discussion about the long-term use," he said.
Jodie Tillman can be reached at [email protected] or (813) 226-3374.