Substantial Sex Differences Found in Opioid Use Disorder Patients

MacKenzie Peltier, PhD

Identifying sex-specific differences for patients at risk of negative outcomes opioid use disorder (OUD) in co-occurring medical, psychiatric, and pain-related diagnoses could be dividends, particularly among US veterans.

A team, led by MacKenzie R. Peltier, PhD, Department of Psychiatry, Yale School of Medicine, identified some of the sex-differences between OUD patients in an effort to drive treatment decisions.

The Problem

OUD and overdose rates are increasing among US veterans and have been a major focal point for the Veterans Health Administration (VHA). The rates of multimorbidities are likely to vary between men and women patients with OUD, which could have treatment implications

In the study, the researchers used data on all veterans receiving VHA health care between October 2011 and September 2012 who were diagnosed with opioid dependence or abuse.

The researchers compared these patients by sex on proportions with OUD and among those with OUD on sociodemographic characteristics, medical, psychiatric, and pain-related diagnoses, as well as on service use and psychotropic and opioid agonist prescription fills.

During the study period, there were 48,408 patients diagnosed with OUD, 5.77% of which were women. However, there were few sociodemographic differences observed between sexes in this patient population.

Sex Differences

But the researchers did find female veterans had a higher rate of psychiatric diagnoses, particularly mood, anxiety, and personality disorders. Women also had higher rates of pain-related diagnoses, including headache and fibromyalgia.

On the other hand, male veterans were more likely to have concurrent, severe medical co-morbidities, such as hepatic disease, HIV, cancers, peripheral vascular disease, diabetes and related complications, and renal disease.

Overall, there were few differences identified in health service utilization. Women did report greater receipt of prescriptions for anxiolytic/sedative/hypnotics, stimulants, and lithium.

Also, men and women did not differ in receipt of opioid agonist medications or mental health or substance use treatments.

“There are substantial sex-specific differences in patterns of multimorbidity among veterans with OUD, spanning medical, psychiatric and pain-related diagnoses,” the authors wrote. “These results illustrate the need to view OUD as a multimorbid condition and design interventions to target such multimorbidities. The present study highlights the potential benefits of sex-specific treatment and prevention efforts among female veterans with OUD and related co-occurring disorders.”

A Potential Answer

Recently, researchers found patient-reported outcomes (PRO) in the treatment of opioid dependence may be affected by the method of treatment.

Investigators, led by Fredrik Tiberg, PhD, of Camurus, found that patients in treatment receiving depot buprenorphine self-reported an improved treatment satisfaction compared to those receiving daily sublingual (SL) buprenorphine.

According to investigators, there is an increased interest in using PRO as an alternative end point for assessment and comparison of different medication in addiction outcome studies.

Data shows the mean daily dose of SL buprenorphine was 15.6 mg/d and the mean weekly depot buprenorphine dose was 21.5 mg/week and mean monthly dose was 107.4 mg/month.

The study, “Sex Differences in Opioid Use Disorder Prevalence and Multimorbidity Nationally in the Veterans Health Administration,” was published online in the Journal of Dual Diagnosis.