She never thought it would happen to her.
Sandra Godwin was a professional woman in midlife, happily married, raising her niece. She had it all: a home in Georgia raising the next generation, a good job in the financial industry.
Not your usual picture of a recovering opioid addict.
But Godwin is indicative of alarming trends highlighted by The Centers for Disease Control and Prevention earlier this year: The number of middle-aged women overdosing on anti-depressants and opioids (both the kind that are legally prescribed by doctors and those obtained illegally) has increased dramatically in the past 18 years.
The statistics are like a punch in the gut: From 1999 to 2017 the rate of these deaths in women age 50 to 54 increased by 350%. For women age 55 to 64 it was even worse—nearly 500%.
And in deaths from prescription opioids alone, the number jumped 1000% in women aged 55 to 64.
The numbers stand out because much of the studies and furor have focused on young people, but the middle-aged of both genders need to be aware of the risks.
Part of the problem? People in their 50s and 60s figure they’re well past the point of becoming an addict, so don’t heed the danger signs that they’re becoming hooked.
“It’s a common mindset that if you’re successful, you have a job and you have a family, you don’t think you’re going to succumb,’’ says Tricia Hudson-Matthew, director of the Center for Addiction Studies at Metropolitan State University of Denver.
Godwin can tell you: That’s not true.
“All it takes,” she says, “is a major health issue.”
“You have to get it together”
For Godwin, it was colon cancer.
Surgery left an aching line of staples across her belly, and chemotherapy compounded her pain. As is common, Godwin’s doctors prescribed opioids to treat her cancer-related pain.
She took the medication as directed. During her six months of chemotherapy she didn’t feel she was addicted.
That changed, though, after she finished chemo. She started regularly taking the maximum dose, and asking her oncologist to increase her dosage. Her oncologist complied for a few months, then referred her to pain management specialists.
That was late in 2010.
The pain management doctors also approved her requests for higher doses. Godwin never needed to find drugs from friends, or on the streets—her doctors always wrote the prescriptions she requested.
Her addiction went on for years, and took a toll on her relationships. She lost friends, and it was hard on her marriage. She would fall asleep sitting up, eating a salad, a fork still in her hand.
Her husband would say, “Sandra, you have got to get it together.”
Just a way to cope
Problems with drugs can start with a health crisis, as in Godwin’s case. For women especially, they can also start with a struggle to cope with a stressor like the death of a parent, or to deal with the competing demands of a career and children—even adult children.
Stressed or anxious women might get a prescription for Percoset after a minor dental or medical procedure. They find that those painkillers do more than take away physical pain, says Michael Genovese, a psychiatrist and chief medical officer at Acadia Healthcare, a company that treats people with addiction.
“Pain medications make you feel, for a brief period of time, calmer and less stressed,” he says.
So, these women ask their doctors for another prescription. And while doctors are getting more reluctant to prescribe opioids, middle-aged women can be convincing.
“We’re seeing a decrease in prescribing but not enough, especially to women 45 and older,” says Hudson-Matthew. “Doctors see them as mature, and good decision makers,” says Hudson-Matthew.
Women who misuse prescription medication don’t necessarily even see their drug use as a problem. They see it as a way of coping, says Maria Ulmer, a regional executive director at Delphi Behavioral Health Group.
And getting prescription drugs from a doctor—not off the street—seems acceptable to them.
When you know you have a problem
In 2011, Godwin hit bottom, struggling with depression and weeping. Along with the after-effects of her illness, she had been dealing with unemployment, another stressor. On the bad days she would look at old copies of her resume and muse on her achievements, all in the past.
She tried to break the addiction on her own, but the withdrawal symptoms would make her feel terribly sick with pain, sweating, nausea and vomiting.
“I always believed each time I was going to do it, but I always failed,” she says.
A friend who was recovering from addiction suggested that she get methadone treatment, which can block withdrawal symptoms. But Godwin believed then that taking methadone was trading one drug for another.
Her friend’s good health eventually changed her mind.
“I started noticing how well she was doing, and I wanted that for myself,” she says. “She wasn’t high, she was just doing well.”
Godwin finally sought treatment in 2012, three years after her cancer diagnosis. Luckily, it worked, and she’s now tapering down her methadone dosage.
Addiction can stretch for decades
The opioid epidemic began back in 1991, so some women in their 40s, 50s, and 60s have been struggling with addiction, and risking overdose, for many years.
No one knows exactly what causes addiction, but certain factors increase your risk: a genetic predisposition, environmental risk factors, early childhood trauma, and mental health conditions like anxiety or depression.
And quitting isn’t an attractive option if it means admitting you’re an addict, especially when there’s still a stigma attached to addiction, says Sarah Akerman, a psychiatrist who works with women with opioid-use disorder and the senior medical director at Alkermas, a pharmaceutical company.
If you were brought up to think addiction is something that happens to weak or bad people, it can be hard to give up that mindset, Genovese adds. And that mindset can prevent middle-aged and older people from seeking help.
It’s not just stigma. People can be afraid to give up the appearance that they have it together.
“They feel it reflects poorly on them if they aren’t able to control their own behaviors and make better choices,” says Deja Gilbert, CEO of Futures Recovery Healthcare in Tequesta, Florida..
“We need to get people to understand that addiction is not a personal failure, it’s something we can treat. There’s no reason not to reach out for help,” she adds.
How to protect yourself
Many addictions start with prescribed painkillers. “There’s a physical dependence on opiates. Even if you take them as prescribed you can become physically addicted, and then it’s very painful to stop taking it,” Gilbert says.
So if your doctor prescribes a painkiller, ask about the risk of addiction.
“The number one question is, ‘What is the projected length of time you anticipate me taking this?’ If it’s something along the lines of, ‘Indefinitely,’ ask what alternative options you have,” Gilbert says.
If you’re being treated for chronic pain, ask about alternatives like physical therapy, cognitive behavioral therapy, and nonnarcotic medications.
Ask whether you should be screened for depression, as it is a risk factor for addiction. And if you have family members who have struggled with substance abuse, make sure your doctor knows.
“Taking five minutes to have that conversation really could change someone’s life,” Gilbert says. “I see people all the time who were prescribed a five-day prescription and six months later they can’t get off it.”
Watch for warning signs
People who are misusing drugs may not see the signs of trouble themselves. “Other people may have to tell us. We may not see it. Others may let us know they’re worried,” says Ulmer from Delphi Behavioral Group.
Friends and family members might have concerns about:
- Change in mood
- Missing social events
- Missing work
- Missing activities that are part of the daily routine
- Unexplained illnesses
- Not feeling well or looking healthy
- Social isolation.
- Being secretive
- Not sleeping well
- Not eating well
- Wearing long sleeves in warm weather
Rebuilding a life
And Godwin? She’s rebuilt her life. She now manages her husband’s company. And as part of her recovery, she called, texted, or wrote letters to the family members and friends she had alienated during her addiction.
“I was able to restore almost every one of those relationships,” she says. “I’m very grateful to be where I am today.”