Substance Use Among Women


By Iris Smith, Ph.D.


There has been a dramatic rise in the use of opioids among all population groups in the U.S. over the past 20 years, especially among women. Since 1999, women’s opioid overdose deaths have increased 642 percent compared to a 439 percent increase among men. Between 1999 and 2015, there was an 850 percent increase in the number of deaths resulting from synthetic opioid use among women.1

The consequences of alcohol, opioids, and other illicit drug use in pregnancy are of particular concern. For over 50 years, extensive studies have shown the effects of prenatal alcohol exposure.  Effects include increased risk for a continuum of poor outcomes including low birth weight, growth deficiency, damage to developing organs, learning disabilities, and other intellectual deficits.

Much of the research on opioid exposure has focused on maternal use of heroin and methadone which has been associated with maternal and infant complications including prenatal growth deficiency, preterm birth, birth defects, and neonatal abstinence syndrome (NAS). Neurodevelopmental outcomes related to prenatal exposure to synthetic opioids such as fentanyl and its analogs is not fully understood. Research to date suggests that prenatal exposure to synthetic opioids results in decreased cognition and psychomotor performance in infancy and early childhood.2 Research on the effects of other drugs such as methamphetamines and polysubstance use during pregnancy is limited.3

Despite the proliferation of research on prenatal exposure to drugs and use among pregnant populations, research examining gender-specific differences in risk factors, patterns of use, and effective treatment models for women in general is limited.  There is a lack of evidence regarding the comparative effectiveness, safety, and cost-effectiveness of various treatment approaches including pharmacologic treatments.3 

A 2022 systematic review of 316 U.S. clinical trials of substance use disorders (SUDs) completed between 2010-2019 found that only 8% of the studies reviewed reported sex-specific analyses and only 1.5% reported transgender participants.4 When adequate data on sex and gender differences have been evaluated (for example in studies on tobacco cessation), clinically significant differences have been observed between women and men. Research data also suggests that sex and gender may be predictive of outcomes for some pharmacologic agents.5  These studies highlight the need to address substance use among women from a life course perspective that extends beyond pregnancy and the childbearing age range.  



1 Cook JL (2022).  Epidemiology of Opioid Use in Pregnancy.  Best Practices Research Obstetrics Gynecology 85 (Pt B); pg. 12-17. doi: 10.1016/j.bpobgyn.2022.07.008.

2 Lee JL, Saraiya N, Kuzniewicz MW (2023)  Prenatal Opioid Exposure and Neurodevelopmental Outcomes.  Journal of Neurosurgery Anesthesiology; 35(1); pg. 142-146.

3 Edge R (2019) Buprenorphine for Opioid Use Disorders During Pregnancy:  A Review of Comparative Clinical Effectiveness, Safety, Cost Effectiveness, and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health.  Available from:

4 Gunn CM, Pankowska M, Harris M, Helsing E, Battaglia TA, Bagley SM. The Representation of Females in Clinical Trials for Substance Use Disorder Conducted in the United States (2010-2019). Addiction. 2022 Oct;117(10):2583-2590. doi: 10.1111/add.15842. Epub 2022 Feb 27. PMID: 35165969.

5 McKee SA, McRae-Clark AL. Consideration of Sex and Gender Differences in Addiction Medication Response. Biol Sex Differ. 2022 Jun 27;13(1):34. doi: 10.1186/s13293-022-00441-3. Erratum in: Biol Sex Differ. 2022 Jul 13;13(1):38.


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