Sex as a Biological Variable and Gender as a Social Construct in the Treatment of Opioid Use Disorder

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Abstract The opioid crisis has devasted individuals, families, and communities in the United States and abroad. Improving opioid use disorder (OUD) treatment requires a nuanced understanding of the risk factors associated with the onset of OUD, and barriers to successful, long-term recovery. Women and men might have several unique risk factors for initiating opioid use, progressing from non-medical opioid use to OUD, and experiencing negative OUD treatment outcomes. These unique risk factors are best understood by examining sex as a biological variable and gender as a social construct in persons with OUD. Toward this end, the research reviewed in this chapter includes sex-based biological factors that affect opioid use, such as neurohormonal interactions with the endogenous opioid system and sex-based differences in neural development, as well as gender-based societal influences that can lead to OUD and potentially stymie attempts at treatment, such as traditional gender roles within the family unit and stigma surrounding OUD treatment. Factors that encompass the intersection of sex and gender are also discussed in the context of OUD treatment, including co-morbid mental health conditions, chronic pain, and response to medications for OUD (MOUD). Building on the preclinical and clinical research on these topics, future studies should aim to optimize pharmacotherapeutic approaches within subpopulations of women and men with OUD, develop strategies to better engage women and men with childcare responsibilities in OUD treatment, and reduce stigma associated with living with OUD and seeking treatment for OUD.