Girls and Opioids: Vulnerabilities & Opportunities

In two separate blog posts in 2016, we discussed opioid use rates and substance use issues among adolescent girls involved with juvenile justice. In July 2017, the United States Department of Health and Human Services, Office on Women’s Health (OWH) released a report on opioid use, misuse, and overdose in women. The report provides information on the gender-specific issues and gaps in knowledge regarding females with substance use concerns/disorders.

The report discusses the differences among females and males regarding the progression of substance use, the biological, social, and cultural issues (e.g., pain; relationships; family/parenting; trauma, determinants of health), effective treatments and barriers to implementation, and areas for further research. As it relates to adolescent girls (ages 12-17 years old), the report indicates they are more likely to use and become dependent on non-medical uses of prescription drugs as compared to adolescent boys. Access to prescription drugs can come from a home medicine cabinet and may help relieve mental health or physical pain symptoms and/or be part of their peer culture.

Other National Efforts

Testimony from leaders during the President’s Commission on Combating Drug Addiction and Opioid Crisis meeting in June communicated important recommendations relevant to the opioid problems given that death rates have quadrupled since 1999 and other serious consequences (e.g., family; long term health issues; loss of productivity). The Commission emphasized:

• Delaying the onset of any type of substance use is critical to preventing the long-term consequence of addiction. Studies find the younger a person is when they first initiate substance use; the more likely they are to develop a substance use disorder over time. To achieve this, collaborate with communities, schools, and justice to implement evidence-based prevention including screening, brief intervention, and referral to treatment, develop or improve policies and practices for a continuum of services and supports, and eliminate stigma associated with substance use and help seeking.
• Improving the implementation of evidence based prevention and treatment through workforce development, financing, and accountability. Repeatedly, the Commission said the science is solid, yet implementation is low. In other words, there studies and experts that have demonstrated and communicated, “What works,” but providers and communities don’t actually implement these strategies, services and supports, or treatments. Translating science into practice requires leadership, resources, training and technical support.
• Using strategies such as systematic screening, assessment, and access to evidence based care to reduce the number of people with substance use concerns in the justice system.

The Commission is recommending rapid responses with scalable solutions to address this epidemic in communities across the country. What was missing from the discussion was the importance of being mindful of culture in any type of response. We know strategies to engage and respond to girls are different from boys as well as those for diverse racial and ethnic backgrounds, gender identity and sexual orientation, and where one lives (e.g., urban; rural). Considering cultural context is imperative to the successful implementation and adoption of any types of services and supports.

Medication Assisted, Counseling, and Behavioral Treatments

Medication-Assisted Treatment (MAT) combines medications to help people reduce the physiological cravings of alcohol, tobacco, and other drugs and behavioral therapies address the thoughts, behaviors, and other factors associated with substance use disorders (e.g., mental health symptoms and trauma; disparities).

Medications found effective for treating opioid addiction are methadone, naltrexone, and buprenorphine. Methadone is approved for use for people 18 years or older. Few studies have examined the effectiveness of naltrexone for adolescents, but experts suggest it is promising. Buprenorphine has been approved by the Food and Drug Administration for use with young people 16 years and older and has research to support its efficacy when combined with behavioral treatments for adolescents.

We must not forget the seminal report by the former United States Surgeon General on alcohol, drug use, and health. It provides background and recommendations for prevention, treatment, recovery support, and health care.  A primary theme of this report highlights treating substance use concerns/disorders as a chronic health condition rather than moral failing. Research shows medications, counseling, and behavioral therapies effectively treat substance use disorders whereas punitive approaches such as incarceration do not. 

Applications for Reclaiming Futures

The Reclaiming Futures approach has been shown effective for getting young people the services and supports they need. As such, Reclaiming Futures sites are leaders in the identifying and connecting young people to resources in their communities. So, continue what you are doing and constantly find ways to improve quality and use the latest research to guide decision-making.

Here are some other ways sites can respond specifically for girls of diverse racial and ethnic backgrounds:

• Identify gender-specific and culturally responsive approaches used to screen, assess, and coordinate services in your communities. If there are gaps, consider ways to improve the community directed response for adolescent girls. Key considerations include mental health services including trauma, family supports, sexual health, positive human development opportunities and activities (e.g., family engagement; education; civic involvement and leadership; recreation; recovery support).
• Check out your local resources for MAT. What are the requirements? How do families pay for services? Are there age limitations? Where are they located and how accessible are they? Are services gender-specific and culturally responsive for the community for which they serve?
• Meet with local leaders to determine what, if any, policies or procedures are being implemented to address the opioid crisis and what is missing? What is explicitly inclusive for adolescent girls?

All across the country, families and communities are losing loved ones and becoming activists to prevent other families from experiencing this pain and suffering. Prevention is collaborating to activate coordinated community responses. Law enforcement, medical first responders, and juvenile justice are working to implement interventions. Behavioral health is working in creative ways to offer MAT, counseling, and other treatment. Responding to substance use and misuse for young people requires increased collaboration, coordination, and messaging about its tragedies, victories, and everything in between.

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Authors Note: Discussion of gender in this blog post assumes biological sex at birth since the documents reviewed did not specify. For consistency, this was maintained throughout the blog post. Reclaiming Futures is cognizant of and respectful that gender is not a dichotomous construct, but a continuum of identities.