Syndemics and the etiology of opioid misuse among women: A qualitative study

Abstract

The opioid epidemic remains a public health priority in the United States. There is evidence that women are experiencing disparities within the epidemic, including an earlier onset of prescription opioid misuse and a higher prevalence of child maltreatment, interpersonal violence, and mental health disorders. The purpose of the current study was to explore the social context of opioid misuse initiation among women using a syndemics framework. In-depth interviews were conducted between July 2019 and February 2021 with 56 women who had a past-year history of opioid misuse. Interview transcripts were transcribed verbatim and analyzed with MAXQDA software. Thematic content analysis was used to develop a detailed explanation for the social process of opioid misuse initiation among women through the lens of syndemics. Women's shared experiences provide evidence of the co-occurring and synergistic factors that increase their risk for initiating opioid misuse and constitute syndemic conditions. Findings revealed the centrality of traumatic events in women's lives; child maltreatment, particularly sexual violence and parental substance misuse, were prevalent and influential to women developing patterns of substance misuse as a way to cope with emotional pain. The presence of pain conditions that conferred access to prescribed opioids further compounded women's vulnerability for opioid misuse initiation. The syndemic conditions that women experience represent a critical call to action to prioritize women's health and social needs within the opioid epidemic. Prevention strategies should address violence against women and girls, as well as pain management practices that attend to trauma and psychological distress.