The Crisis Corner: Women, The Opioid Crisis, And The Truth About America's Front Lines

“The only way I can describe it to you is…it’s like kissing Jesus would feel.” 

These are the words a heroin-addicted woman used to describe the high that follows an injection. 

They were spoken to advocate and activist Necia Freeman, a woman on the front lines of America’s deadly opioid crisis. Her story of outreach and faith is one of three featured in Netflix’s Oscar-nominated documentary Heroin(e). 

Watching this film, I experienced such a potent range of emotions that I was left restless and almost numb. It’s a familiar feeling for many Americans. Faced with the reality of our nation’s increasingly visible, heartbreakingly prevalent struggle against opioid addiction, we often feel helpless and overwhelmed.

The factors behind this crisis are both shockingly simple and overwhelmingly complex. Many of us are left grappling with a single question: what can we do to stop this? 

Answers to that question are starting to emerge, albeit slowly. To understand this crisis and its possible solutions, we must first understand the personal stories, everyday tragedies, and small victories that exist at the heart of America’s fight against opioid addiction. 

Many of these stories belong to women. And those stories – the ones that occupy the intersections between womanhood and addiction – are unique.

A Hollowed-Out World – Where Numbers End, Human Lives Begin

When you take your first look at the opioid crisis, you’ll be confronted with numbers. So many of them, in fact, that just glimpsing the data can be overwhelming. 

These numbers are shocking in scope. And yet they are sanitized in their inability to express the human scale of what’s happening in our towns, cities, and rural communities. Nevertheless, these numbers begin the story of our opioid crisis. They are chapter one, and we cannot talk about addiction without confronting them head-on.

At least 2.1 million Americans currently suffer from Opioid Use Disorder (opioid addiction). The actual number may be significantly higher since many people do not report their addiction (mostly due to social stigma).

More than 500,000 Americans are addicted to heroin to the point of physical and psychological dependence. Heroin is the drug most people leap to once they lose access to prescription opioids.

In the space of a single year (2021), the U.S. saw 80,816 deaths by overdose. A significant portion of these deaths occurred as a direct result of heroin or other opioids (as opposed to substances such as methamphetamines or crack cocaine). 

Globally, at least 35% of female sex workers are addicted to illicit drugs, with around 55% having been addicted before becoming involved in prostitution. 

The numbers are shocking because of the truths they reveal. Addiction isn’t isolated, and it isn’t rare. It’s disturbingly common. It touches all of us, whether we know it or not.

There are places in America where entire generations have vanished into the murky waters of the Opioid Crisis. In some areas, it’s possible to find entire neighborhoods transformed into ghostly shells of the vibrant working-class communities they once represented.

In other neighborhoods, the reality is even starker.

These are the shadow-streaked, trash-littered corners where women and girls fight their way from hit to hit and sell access to their bodies to men they’ve never met. These men frequently abuse them. Sometimes they take their lives. 

In other hidden pockets of this diverse nation, the reality of addiction is more intimate but no less dangerous for women with opioid dependency. Even within the home and family unit, addiction begets violence, psychological trauma, and domestic abuse with routine frequency.

Women with addictions face higher abuse rates from intimate partners and are far more likely to become victims of homicide than non-addicted women. They are more likely to be coerced into giving up their autonomy, freedom, and personhood in return for access to the opioids their bodies and minds depend on. 

Sometimes they trade their safety in exchange for a roof over their head and a place to sleep when they have nowhere else to go. Abuse is the price they pay for all of the things addiction has stolen from them.

With addiction comes higher incidences of STDs, more miscarriages, higher maternal and child mortality rates, more pregnancy and delivery complications, and more pain for the women who struggle with the disease. It compounds suffering and multiplies the struggles women already face within our society. 

Even when women are not the addicted party, a disproportionate number face violence and death at the hands of loved ones who are. Opioids are, in a way, a magnifying glass pointed at all of the forms human suffering already takes – forms like poverty, disease, loneliness, and mental illness. 

The numbers tell us that there is a problem. They give us a glimpse of the incredible scope of that problem on a broader scale. For this reason, they are a vital piece of the addiction puzzle. 

But numbers are not people, and eventually, we find ourselves up against something far more profound. This is a human crisis, and individual stories form its beating heart.

Not Saying No: How And Why Women Become Addicted To Opioids And Other Substances

In recent years there has been increased discussion about addiction and what it actually means for those suffering from its effects. Old ideas and stereotypes about addicts are being dissected, and fresh research is shedding light on the reality of addiction as a physical reality rather than a moral choice. 

“Experts now realize that addiction is not a choice or a demonstrable lack of character, but a disease – complete with traceable genetic markers, measurable brain differences, and a host of innate risk factors that define an individual’s relationship with addictive substances long before they swallow their first pill.” 

We now know that our brains contain receptors specifically tailored to interact with opioids. We know that addiction has hereditary components and that certain experiences in-utero can increase a person’s likelihood of one day becoming addicted. Researchers have been able to trace the complex biological processes that together form what we know as “addiction,” and thanks to their work, we are able to view addiction not only as a mental illness but also as a physical one.

We can also grasp that there is a choice factor within the tangled web of addiction and relapse. The ways that addicts and future addicts make their choices in life matter and those choices can be traced back to certain worldviews and day-to-day realities. 

We understand that a person’s psychology and circumstances can drastically affect their chances of experiencing addiction and impact their likelihood of recovering from it once it’s set in. Addiction represents a battle that must be fought on multiple fronts. An individual can’t be separated from their circumstances. We all make decisions based on the reality we’ve been born into and raised to take for granted. The socio-environmental factors behind addiction are an intrinsic part of the disease itself, and we have to take them seriously in order to offer effective solutions to those suffering from it.

Biological sex and gender identity have a dramatic impact on the forms these socio-environmental factors take. These are the forces that live behind the whys and hows of addiction. They form the personal experiences that lead people toward addiction and determine how an individual responds once that addiction has taken hold of their lives. Gender and sex are innate components of our identities and therefore form integral parts of our relationship with addictive substances.

“To put it simply, women become addicted for different reasons than men; once addicted, the ways they secure their drug of choice are also different.” 

The Needle’s Edge: Work, Poverty, And How They Impact Women’s Experiences With Addiction

The impact women’s addictions have on their communities is different from the impact men’s addictions have on those same populations. Gender hierarchies and social norms play a major role in how addictions form and propagate.

For one thing, women who suffer from any sort of substance use disorder are significantly more likely to become the victims of rape, assault, and homicide. Conversely, women who have been abused are much more likely to become addicted to substances, usually as a coping method to handle their trauma. The cycle perpetuates from both ends of the abuse spectrum and becomes a chicken-versus-egg issue that is difficult to decipher.

Women partnered with men who have a substance use disorder face similar increases in risk. This makes them “secondary casualties” of the disease.

The impact of addiction on a woman’s financial and career prospects cannot be overstated. A large part of this impact can be seen in the connections between opioid addiction, illegal sex work (such as prostitution), and sex trafficking as a global industry. 

Women with addictions are exponentially more likely to turn to sex work than men or non-addicted women. This is usually due to financial desperation. Addicted women need to earn money for basic survival (shelter, food) and for continued access to the drugs they’ve come to depend on. At the same time, addiction makes a steady income far less accessible. 

This simple fact exposes addicted sex workers to a slew of possible abuses from clients, law enforcement, and society at large –  and to the flaws of our tragically inequitable, retribution-based justice system.

Sex work and addiction tie directly into the unique, gendered experience of criminality and punishment within our society. It also impacts the way millions of women engage with experiences like motherhood, intimacy, and romantic relationships. 

Sex workers and addicts are both more likely to: 

For trans or non-heterosexual women, the picture is even bleaker. They are often abused more directly by the very systems that are supposed to protect them.

Another, lesser-known factor tying gender to opioid use is the greater prevalence of chronic pain and related issues in women as opposed to men. Recent data has shown that women are more likely to be given opioids legally due to a diagnosis of anxiety or chronic illness. This is compounded by the fact that women are also more likely to seek help for these issues in the first place. 

Once prescribed, women tend to become addicted to opioids more quickly than men and are more likely to relapse after attempting to get clean. This is widely considered to be a matter of women’s metabolisms and the frequent hormone changes they experience throughout their cycles.

Sex and gender-based health factors mean that women are the fastest-growing demographic regarding addiction and substance-use disorders such as OUD.  

These gendered issues are complicated and still full of gaps as far as studies and research go, but one thing has become increasingly clear: in all of its variations, womanhood interacts with addiction and influences how it affects individual lives. 

What about the solutions to addiction? What role does gender play in recovery and rehabilitation? The answers to these particular questions can also be complicated. At the same time, they’re hiding in plain sight. 

We simply need to open our eyes.

Photo by Matteo Badini on Unsplash

Countered Intuition: Radical Solutions Are Hiding In Plain Sight, But Americans Don’t Want To Hear Them

In the slums and working-class hovels of Industrial Era London, a full 76% of female sex workers were infected with some form of venereal disease. Many of them ended up disfigured from their illnesses, and a vast proportion of them would eventually die as a direct consequence of their work as prostitutes. 

Thanks to efforts by public officials, advocates, ex-prostitutes, and a bevy of awareness campaigns, this reality was completely changed by the early twentieth century. 

Why the history lesson? It holds valuable insights for those seeking to fight the opioid epidemic and improve the health outcomes of those suffering from addiction. 

We’ve already discussed the parallels between addiction and sex work, and many solutions occupy these parallels and tackle both issues at the same time. 

In Amsterdam, sex work has been legalized and is subject to government regulation. In these places, sex workers are far less likely to contract STIs like HIV/AIDS, chlamydia, gonorrhea, and HPV. Legalization also decreased sex workers’ risk of suffering from unwanted pregnancies, reproductive crises, and violence-related injuries. 

It hasn’t solved every issue, but legalization has certainly removed the curtain of secrecy surrounding sex workers and given them access to help and resources they were prevented from using when their work was criminalized.

Just as criminalizing sex work leads to more rather than less venereal disease, criminalizing addiction has a demonstrably negative impact on those who are suffering from the disorder. It hasn’t prevented people from becoming addicted in the first place, and it hasn’t reduced the targeted behaviors or negative health outcomes that opioid addiction brings with it.

Basically, criminalization makes the problem worse.

Providing sex workers with free/accessible testing, contraception, legal recourse, and safe work environments helps to reduce the social ills associated with unregulated prostitution. Why can’t the same model prove successful against the opioid epidemic? In some countries, it already has. 

When nations like Portugal, Switzerland, and Czechia decriminalized drug possession and use, they saw disease rates plummet. Addicted people were able to access resources and seek the help they were too afraid to seek before decriminalization, and this has contributed to better outcomes for those struggling with substance abuse disorders within these countries. 

Freed from the fear of jail time or heavy fines, addicts are more likely to seek rehabilitation and recover from their addictions. Time and time again, the data has shown that decriminalization works. Not only for addicts themselves but also for the communities and families they are a part of.

At the root of our problematic relationship with addiction is a core set of stigmas associated with the disease. This is one of the first things that must be addressed if we want to explore the idea of rehabilitation – rather than retribution – for women addicted to opioids. 

As most addicts can tell you, they don’t want to be addicted to heroin or pills or anything else. Most of them wish they could go back in time and change the decisions that led to them trying their first, often legal pill and, by extension, their first hit of a not-so-legal opioid down the road. 

Punishing people, especially those who are already oppressed and disenfranchised, is unhelpful at best and downright cruel at worst. We don’t punish people for having other kinds of illnesses, so why are we punishing those suffering from the disease of addiction? 

Why do we cringe away from the idea of providing safe, monitored places for addicts to get help or, at the very least, to get high safely, without posing a danger to themselves or others? 

Why are we reluctant to use public funds to open up free, non-religiously affiliated rehabilitation centers for the chronically addicted? 

Why do our policymakers refuse to open up institutions that can provide inpatient psychiatric care for long periods of time, and instead choose to over-fund the policing institutions that essentially punish addicts for having a treatable disease?   

The answers to these questions are probably the same ones we’d give if asked about legalizing sex work or, at the very least, de-criminalizing it and offering resources to the women who provide these services to countless men. 

Men who, it might be mentioned, are unlikely to be punished for seeking those same services on a regular basis.

The parallels are obvious, as are the causes behind our lack of meaningful action on either issue.

We’ve been taught to view poverty, addiction, and crime as black-and-white issues (sometimes literally) comprised of “bad” or “weak” people versus everyone else. And although the conversations surrounding these issues are starting to shift and broaden, our instinctive, snap judgments remain largely the same as ever. 

Until we confront our national tendency to see addicts as weak, lazy, criminal, or otherwise “bad,” we’re going to continue spiraling into a crisis that’s largely of our own making. Women with addictions are not failures. They are not “bad” mothers who don’t care about their kids. They don’t deserve abuse, and they aren’t choosing to be addicted any more than someone chooses to have cancer or diabetes.

Compassionate and realistic solutions are drastically more effective than our current punishment-oriented approaches toward addiction, especially among addicted women. 

The best way to explain this concept is through a typical real-world example.

American Gothic, The Opioid Edition: Portrait Of A Woman In Crisis 

Want to understand the opioid crisis? Picture this.

A woman, let’s call her Cindy, is a single mom with three kids. She’s been raising them without help since escaping an abusive ex-boyfriend and currently works in retail for a minimum wage. 

While at work, Cindy throws out her back. She’s given some workman’s compensation, but it’s minimal. She can’t afford a lawyer to negotiate for more on her behalf. 

She goes to the clinic and quickly realizes she can’t afford long-term physical therapy or surgical intervention to fix her back, but she’s in pain and fears she might be unable to do her job if she isn’t given some kind of treatment. 

The doctor sympathizes with her and prescribes opioid painkillers to offer her some relief.

She becomes dependent on the pills. After a few months, she gets a DUI, and her prescription is pulled. She soon spirals into agonizing, non-stop withdrawal symptoms. Before you know it, Cindy switches to heroin and gets fired. Desperate, she begins to earn money as a sex worker. She starts out online but eventually turns to riskier and riskier avenues as her addiction worsens and her support network disintegrates.

Her housing situation becomes unstable. CPS limits her access to her children – who were placed into the foster care system during one of her relapses – and the only resources she can access are periodic food donations and occasionally a bed in a homeless shelter (but only when she’s “clean”).

Cindy is left largely on her own, and she has little chance of rehabilitation. Ignored by society, most people look away when confronted with her suffering. We blind ourselves because this reality is uncomfortable.

Cindy’s story is America’s story, and it represents everything we’re doing wrong regarding the opioid crisis.

Photo by Oscar Keys on Unsplash

Cindy’s story highlights some of the most common and well-researched events that Americans report when sharing their substance addiction stories.

A lack of adequate healthcare leads to quick-term solutions involving painkillers. Addiction sets in, job loss follows, and these problems build on each other until the addicted person is embroiled in a full-blown crisis. 

Let’s look at two possible paths for Cindy, each of them largely dependent on the policies and perceptions surrounding her demographic in the United States. You decide which option is better for her – and for society as a whole.

Option 1: Cindy can be arrested on either possession or prostitution charges again, get put through the court system, and either end up serving jail time as a repeat offender or get sent back out into the streets with yet another item on her record. She might be given access to a privately-funded rehab program through a judge or social worker, but it will be short-term with a low long-term success rate (most enrollees relapse within 6 months of completing the program).

She probably won’t know how to apply for public housing and can’t stay at most shelters for more than a night at a time – she won’t be able to do either unless she’s totally clean and hasn’t gotten high for an extended period of time. Various non-profits might periodically cross paths with her, but their resources are strained and help is always short-term. 

No one offers her a way to secure even basic physical security, let alone financial security or access to decent healthcare. 

Eventually, she’ll probably die of an overdose, end up murdered by a client or partner, or repeat the arrest-jail-short-term-rehab cycle for the rest of her life.

Option 2: Cindy could be visited by a trained social worker who not only offers judgment-free counseling and therapy, but also helps her to secure access to a safe, clean, and monitored location to get high in while the worker takes up her case. 

She is offered regular access to medications that assist addicts during withdrawal and recovery, such as methadone or buprenorphine. While at the safe location, she will have access to Narcan and trained workers who know how to administer it. 

Cindy will also be given access to a guaranteed spot in a publicly funded, independently monitored housing facility that doesn’t require her to be clean. She can’t get high while she’s home, but there won’t be any judgment levied against her for her addiction. She’ll have a clean bed, regular showers, food, and access to a community of women who know what it’s like to be in her position. 

She will be assigned an accountability partner who is on their own journey and who she can check in with each night and every morning.

She’ll be given a spot in a long-term rehabilitation program that includes in-patient psychiatric and crisis care and outpatient help, a transportation card to make sure she can travel to and from various appointments, will receive routine STD tests and will be given contraception. 

She’ll have regular contact with her social worker, and will not be penalized for relapsing or continuing to perform sex work so long as she is consistently enrolled in the program and has demonstrated a desire to get help.

After one year of enrollment, if she can go at least 2 months without getting high, Cindy will be offered a spot in a back-to-work program that allows her to complete her education, build a resume, and earn some money as she re-enters mainstream society. This program will include a financial literacy component and other resources that make up for the lapses in education and the accommodations she was never given during her childhood. 

By the end, she’ll be well on her way to achieving basic financial security and will have built up a community of women and trained advocates who genuinely want her to succeed no matter how many times she falters.

Which path do you think is more likely to keep Cindy stay safe, out of trouble, and away from criminal activities like theft or fraud? Which path is ultimately better for Cindy’s overall health and security – and therefore for society as a whole?

America spends up to $740 billion on addiction and substance abuse-related costs every single year. That number is growing. Most of these costs are related to emergency healthcare and our overloaded justice system (including those relating to both our state and federal courts as well as our full-to-capacity prisons).

Establishing widespread preventative care, supervised injection/consumption centers, therapy, long-term rehab, secure housing, and a generally non-punishment-oriented system will be expensive, but in the long run, it is likely to save our country money. 

Decriminalization is a radical but demonstrably effective step toward ending the opioid crisis because it allows preventative and rehabilitative programs to become established, normalized, and improved via publicly-funded research initiatives.

Most importantly, it is our best chance at mitigating the already unimaginable suffering faced by addicts and those who love them. It allows addicted people to become productive members of society again – and gives them an autonomous future as individuals…rather than casualties of a treatable illness.

Of course, our approaches to treatment need to take gender and sex differences seriously. 

Photo by Mishal Ibrahim on Unsplash

Women are especially vulnerable to the dangers of addiction – they tend to need more protection and targeted, gender-conscious counseling, and the most effective housing and rehab programs are fully gender segregated. Effective programs don’t shy away from the hard-to-swallow realities that addiction represents. They face them head-on and tailor their approach to suit the needs of their participants.  

Studies have shown that criminalizing women for being addicted to opioids or other substances does not work. Men need their own non-punishment-based care, too, and the women in their lives will play a crucial role in informing that care. 

So, yes, the image of addicted women shooting up in clean, monitored cubicles – with trained, Narcan-armed EMTs standing by – might be shocking to some people. And in a society that has demonized addicts, sex workers, and disadvantaged people for hundreds of years, the idea of “giving away” free housing, food, and medical care might be a hard pill to swallow. 

Doing the right thing is usually difficult. It is often shocking. And when doing the wrong thing is made to feel normal or even right, it takes a lot of effort to step back and see the moral truth. Those struggling with addiction know this better than anyone. 

That doesn’t mean we try to lie to ourselves, manipulate the narrative, or otherwise weasel out of taking that moral path. Many available solutions cost very little in the short-term – a dose of the naloxone-based medication Evzio (the same active ingredient found in Narcan and other overdose-reversal medications) costs around five cents per dose to produce, for example. 

It can stop a lethal overdose in as few as 2-5 minutes. 

As of this writing, the retail price of Evzio runs at about $4,000 per package. This number is not an exaggeration, but it is a travesty. We see similar price barriers when we look at the costs associated with drug rehabilitation facilities, basic housing, adequate counseling services, and just about everything else that might improve the situation faced by addicts and their loved ones.

We can’t afford to let price-gouging and predatory business practices destroy our hopes of a better future, especially when the alternative will cost us dearly in money and lives.

The truth is that we’re all on the front lines of America’s addiction crisis, and it’s not going to get any better until we completely change how we approach the problem. Women are the cornerstones of every community in the nation – and they are also the ones who are, arguably, suffering the most acutely from this crisis. This is true whether they are addicts themselves or simply the loved ones of those suffering from addiction. Addicted men rely on the women in their lives to support and love them unconditionally, but who supports those same women when they fall victim to addiction?


The most effective solutions are radical, and they might seem like hard pills to swallow…but without them, the addiction crisis is going to choke the potential of our nation. Let’s turn the corner.

THIS ARTICLE WAS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR PARTNERS. A HUGE THANK YOU TO DAHIYA FACIAL PLASTIC SURGERY & LASER CENTER FOR Giving us the chance to fight addiction, fight the stigma, and educate The Public about women’s health and wellness.

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Health And Healing, TFW Partnerships, Politics & ActivismEmily Montagueaddiction, opioids, social issues, social justice, addicts, heroin, rehab, recovery, stigma, women's health, mental health, mental illnessComment