What about women?

This is the second in a series of blog posts discussing topics raised at the recent Drug Strategy Implementation Events which Collective Voice delivered on behalf of the Home Office in November 2017.

Back in November, we had a busy fortnight travelling the country with the Home Office and Public Health England, bringing together a wide range of stakeholders to discuss implementing the Government’s new Drug Strategy. What united everyone was a desire to ensure that we as a sector continue to deliver effective, evidence-based treatment to as many people who need it as possible – a desire accentuated by the record levels of drug-related deaths we are currently seeing in this country. Treatment is a protective factor against drug-related deaths, but if treatment isn’t accessible to all sections of the drug-using population, then we have a problem. One section of this population who might be in danger of missing out on the protection treatment offers is women.

At the London event, concerns were raised that drug misuse deaths among women are rising faster than those among men. While the majority of people who die as a result of drug misuse are men, in 2016, female drug misuse deaths rose by 8%, compared with a rise of 2% for men. Two years before they rose by 23%, compared with a rise of 14% among men. If this trend continues, this is worrying.

The reasons for the rise are not clear; one reason posited is that different patterns of use among women might mean that they are less susceptible to overdose when they are younger, but as they age, their susceptibility to overdose matches that of men. Certainly more work needs to be done to establish why deaths might be rising among women.

But what do we know about women in treatment? Is treatment not accessible to women? On the first question, the NDTMS data reveals that people who use drug and alcohol services are predominantly male, with only 31% of service users female in 2016/2017 (falling to 27% of those in treatment for opiate use, but rising to 39% of those in treatment for alcohol dependency only). However, this is largely consistent with the proportion of men and women using drugs problematically as indicated in the Crime Survey for England and Wales and the Government’s estimates of opiate and crack cocaine use prevalence.

The second question is harder to answer. Treatment penetration is higher among women than among men; 33% of female opiate users were thought to be outside of treatment in 2014/15 compared with 43% of male opiate users. This would indicate that, on the whole, women are not prevented from accessing treatment.

However, this does not detract from there being specific barriers to women accessing treatment, which are different to those experienced by men. Issues around childcare and fears that children will be taken away if they admit they have a drug problem affect women disproportionately. Likewise, the link between domestic violence and substance use is well-established; for a woman who has experienced domestic violence from a man, male-dominated drug and alcohol services are an intimidating place to be, and if she is still in the abusive relationship, her abuser might prevent her from seeking help for her substance use. The clinical guidelines state that services need to identify and address the effects of trauma and domestic violence on service users, and this is essential if women in particular are able to be supported effectively by drug and alcohol services.

Consultation by AVA and Agenda indicates that for some female service users, women-only spaces are vital if they are to engage with treatment. However, the current climate puts specialist support such as this at risk; the Recovery Partnership’s recent State of the Sector 2017 report reveals that disinvestment in drug and alcohol treatment is leading to specialist services being cut back, as providers and commissioners are forced to focus on generic services. One chief executive provided the example of a holistic women’s centre with a great deal of local expertise and a flexible approach being threatened, and went on to ask “Why, despite all the evidence, do women need to continue getting treatment in centres that are not appropriate and not child-friendly?”

At the end of the day, evidence-based treatment should be available and accessible to everyone who needs it, regardless of their gender or background. We need to be going out and asking those outside treatment why they do not engage with treatment. That way, barriers to treatment – including gender-specific barriers – can be identified, and services can be designed and commissioned accordingly. Only then will we be able to halt the rise in drug-related deaths, among both women and men.