Investigating addiction

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Dr. Zena Samaan hopes to tackle the stigmatization surrounding drug addiction with her recent study on opioid addiction in women.

Samaan, a Staff Psychiatrist at St. Joseph’s Healthcare and Assistant Professor at McMaster, noticed an alarming trend when speaking to patients about their mental health challenges. Many patients reported opioid prescriptions. Opioids are painkillers that Dr. Samaan has seen given to women post-childbirth, with back pain or have suffered a trauma like a car accident. Painkillers can be prescribed for many years.

“The striking part was that many of them didn’t realize they were addicted to these medications,” said Dr. Samaan, who looked at opiate users within Canada to find a common thread among their addiction.

In order to gather participants for the study, investigators reached out to community treatment clinics. Participants were then asked to identify the factor that first led them to opiate use.

After interviewing 500 people, Dr. Samaan found that 52 percent of the women were first exposed to opiates in the form of a prescription from a physician. This trend was found to be less prevalent in men, with only 33 percent receiving a prescription for the same exposure.

It was also found that male and female addicts had different life circumstances. For example, women with opioid addictions were more likely to have childcare responsibilities. Many of the women in the study were also found to have received an education but not be working, putting them at risk for financial assistance.

The difference might stem from the fact that women are more likely to reach out for medical assistance than men. Furthermore, social stigmas classifying men as risk takers may contribute to a decreased likelihood for men to receive a prescription for painkillers from physicians.

This finding calls for a need in the development of better treatment programs. Dr. Samaan explained, “We need do better in tailoring treatment to what women need and what men need. The treatment at the moment is ‘one size fits all.’”

Nor is the current treatment protocol exactly a quick fix. In the population used for the study, treatments lasted for an average of three years but can extend beyond that.

“At the moment, when somebody has an addiction to opioids, they cannot just stop it. Withdrawal symptoms can be very dangerous — they can have convulsions, seizures, [or lapse into a] coma. The treatment is to substitute what they have been using with a synthetic opioid such as methadone.”

From there, doses are decreased, the ultimate goal being to wean them off drug dependence. Other medications like opioid antagonists do also exist, however methadone remains the first line of treatment in Ontario.

“Some services may have some counselling, but mostly related to how do we make you stop using the drugs rather than what other needs do they have.” In women, this ties back to challenges posed by child bearing responsibilities as well as increased likelihood of familial struggles. The services do not cater to these types of problems at the moment,” laments Dr. Samaan.

With about half of the patients attending treatment centers also suffering from psychiatric problems, there is a dearth of psychological support in treatment.

“What we are advocating for is to have a more comprehensive treatment service [that melds] addiction treatment with mental health [strategies] and social service treatment,” explained Dr. Samaan. This would involve counseling and the cooperation of child protection agencies and social services.

Another option would be to limit the prescription of painkillers in the first place, the use of which for more than a few days is not recommended.

“The other thing this work is showing us is the stigma associated with opioid addiction. People often think that these are young people going out on the streets trying to get high, but in many of these women it is medically induced rather than because of risk-taking behaviours.”

Photo Credit: McMaster Daily News

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