Tag Archive for: substance use

Behind the Science: Breaking the Mold: Gender, Cannabis, and Substance Use Disorders

Interviewee: Dr. Justin Matheson,  | Authors/Editors: Romina Garcia de leon, Janielle Richards (Blog Co-coordinators)

Published: September 6th, 2024

Can you briefly explain your research?

My research focuses on understanding how sex and gender shape substance use health, which encompasses the continuum from initial drug use experiences to substance use disorders. Specifically, in my current research, I am concentrating on two main areas. The first is examining differences in acute responses to cannabis using a human behavioral pharmacology paradigm. In this paradigm, participants smoke cannabis in the lab, and we observe categorical differences in their responses, such as how high they feel and their cognitive and sometimes driving performance. The second focus is on how gender influences trajectories and experiences in cannabis use disorder treatment, including the type and severity of symptoms experienced by individuals undergoing treatment to reduce or stop cannabis use. The aim is to better understand these trajectories, particularly in cisgender women and gender minorities, and to improve prevention and treatment strategies for substance use disorders, especially cannabis use disorders.

How did you get into this research?

I kind of stumbled into this field when, as a PhD student, my supervisor suggested that we explore differences in our initial cannabis lab study for a conference presentation. As I reviewed the literature, I became increasingly aware of how much harm in science has been caused by andronormativity, the focus on men and male bodies. Substance use has often been framed as a “men’s issue,” and addiction in women is less understood, with limited research on addiction in gender minorities. As a gender-fluid person, I felt it was important to work towards gendered health equity in the addiction field within a restorative social justice framework, addressing gaps in understanding how substance use affects cisgender women and gender minorities.

How do you define sex and gender in your work?

Initially, my approach was to use a classic categorical difference model—males versus females. However, I am now shifting towards exploring the underlying factors driving these categorical differences. For example, I am interested in the relationship between gonadal hormone levels and acute responses to drugs, and how these relationships vary with the menstrual cycle or menopause. There is a significant lack of empirical evidence on how menopause might impact addiction risk. While my research is still grounded in binary categories, I aim to move beyond this binary to examine associated factors that affect all bodies differently based on gender. I think of gender as a way of making meaning of bodies and how societal understandings of gender influence how individuals are treated. Historically, substance use has been more stigmatized for women, contributing to underreporting and less focus in research. Women with cannabis use disorders often face more interpersonal conflicts, while men may experience more neurobiological or pharmacological harm. My research seeks to understand how gender and biology interact and how these interactions influence substance use and addiction.

Are there any findings you could share with us?

In our human laboratory work, we’ve encountered challenges. For example, in my initial PhD research, female participants smoked less cannabis than males and had lower THC levels in their blood than expected. Despite reporting similar subjective and cognitive effects as males, the difference in blood THC levels was significant. However, subsequent attempts to replicate this finding have been inconclusive. We are exploring how contextual factors (e.g., mood, expectations, prior cannabis use history) might moderate the relationship between THC exposure and intoxication states. We are also investigating the impact of menstrual cycle phase, estrogens, and androgens on cannabis use. In our gender-related research, which is primarily qualitative, we’ve identified notable gender narratives. For instance, men often seek treatment after struggling to cut back on cannabis, while women frequently cite external pressures and shame related to their cannabis use. These preliminary findings suggest a need for further exploration of how gender influences treatment-seeking behaviors and barriers to accessing care.

Where do you hope to see this work in 10 years?

In the next decade, I hope to secure more funding for research on specific factors related to substance use. There is a significant gap in understanding how menstrual cycle phases impact cannabis use, with only one published study in this area. I aim to fill this gap and explore neuroendocrinological approaches, including hormone modeling and genetic factors. Additionally, I hope to integrate gender more systematically into laboratory studies, moving beyond qualitative research to develop quantitative measures of gender. For example, understanding how individuals who identify as more feminine may experience cannabis intoxication differently could be crucial. Ultimately, I aim to merge research on gender and cannabis use disorder with studies on individual differences in drug responses, to improve prevention and treatment strategies for cannabis use disorders and other substance use disorders.

Where can you learn more about Dr. Justin Matheson’s work?

Website: https://www.justinrmatheson.com/ 

Twitter/X: https://x.com/justinrmatheson 

Understanding Sex Difference in Addiction: The Road to Tailored Treatments

Authors: Tanisse Epp, PhD Student, Carleton University, MSc Neuroscience, University of British Columbia | Editors: Romina Garcia de leon, Shayda Swann (Blog Coordinators) 

Published: Dec 1, 2023

For a long time, society believed that alcohol and drug use was primarily a problem for men. As a result, research has mostly focused on studying addiction in men. But in recent years, there has been more attention to women and how they use drugs and alcohol. As the number of women using drugs and alcohol keeps increasing, closing the gap between men and women has become extremely important. Recently, there has been a promising rise in research looking at sex differences within addiction research. This research has highlighted significant differences in how addiction develops and progresses differently in men and women. These differences have important implications for treatment and relapse risk.

Consumption Patterns 

Despite men having higher rates of substance use disorders than women, women are more vulnerable to many aspects of the disorder. For example, women have a shorter time period from initial drug use to meeting the criteria for substance use disorder and seeking treatment compared to men. This phenomenon is called the ‘telescoping effect.’ It means that women tend to develop problematic substance use issues in fewer years compared to men. This effect has been reported across multiple drug classes, including cocaine, methamphetamine, alcohol, opioids, tobacco, and cannabis, and non-pharmacological addictions, such as gambling

Pre-clinical research has proposed a potential mechanism underlying this sex difference in the nucleus accumbens (the dopamine centre involved in addiction) and the dorsal striatum (the action-oriented center driving the physical action of taking substances). For instance, when exposed to drugs, female rats show a smaller response in the nucleus accumbens at first, but they have a quicker and stronger reaction in the dorsal striatum, driving an escalation in drug use. Additionally, gonadal hormones have been proposed to be involved. Research, both in clinical and pre-clinical settings, has demonstrated that estradiol, a female hormone, can lead to an increased ‘high’ from smoking cocaine and a stronger drive to obtain cocaine. This suggests that estradiol may play a role in the quicker progression from casual to chronic cocaine use in females compared to males. 

Craving

While the telescoping effect plays a significant role in the early stages of addiction, craving becomes a crucial factor in sustaining addiction and raising the risk of relapse after quitting. Exploring potential sex differences in craving will contribute to a greater understanding of how we can support both men and women during abstinence to decrease the risk of relapse. Current research on the sex differences within craving is mixed. Some studies have found no significant differences in craving between men and women for cocaine or alcohol use disorder. In contrast, for opioid use disorder, women have greater craving scores than men. These mixed findings may be related to the involvement of sex hormones in the changes in spine density in neurons and how this impacts craving. Changes to neuronal spine density (how neurons connect in the brain) in the nucleus accumbens are thought to promote craving over time. Sex hormones impact spine density, where testosterone decreases and estradiol increases spine density. The interactions between sex hormones, types of substances used, and their impact on neuronal connections likely contribute to variations in craving.

Psychosocial Factors 

Psychosocial factors are known to impact the onset of addiction, such as stressful life events and childhood trauma. One study found that greater severity of childhood emotional trauma, sexual trauma, and overall childhood trauma was associated with higher cocaine use and an increased risk of relapse in women with cocaine use disorder, and this association was not found in men. This association is not limited to childhood trauma, but previous research has shown that women have a greater daily use of cocaine following stress-induced relapse compared to men. Both stress and trauma-related findings are theorized to be related to hypoactivation observed in the ventromedial prefrontal cortex (vmPFC; a key brain region contributing to reward and decision-making) in women. The dysregulation of the vmPFC is suggested to increase relapse and drug-seeking behaviour in women as it creates a more significant obstacle in self-regulation and control over emotionally regulated behaviours.

Implications and Treatment

While acknowledging the neural and behavioural sex differences in addiction has gained research interest, sex has not been well-considered in the development of treatment options for addiction. While some specific targets, such as noradrenergic, cholinergic, antidepressants, and GABA, have been examined in addiction research, there is a lack of focus on how sex differences affect these areas. Only noradrenergic targets consistently show that women tend to have better outcomes with tobacco and cocaine addiction. However, other treatment strategies, like withdrawal treatment or reinforcement blocking, do not have apparent sex-specific effects. Sex considerations should influence addiction medication and treatment development, given that women often experience more stress-related vulnerability, quicker addiction onset, and severe withdrawal symptoms, making research into these areas essential for sex-informed treatments.

 

*This blog was posted in honour of Substance Use Awarenss Week

Behind the Science: How Women are Fighting the Opioid Crisis


Authors: Arrthy Thayaparan and Negin Nia, Women’s Health Blog Coordinators | Interviewee: Dr. Jade Boyd, Ph.D., University of British Columbia

Published: October 29th, 2021

News of the opioid epidemic is constant in Canada. But what’s discussed in the media rarely goes beyond the scope of updated death rates and the repeated calls for life-saving policy change. That’s why advocates and researchers, like Dr. Jade Boyd, are essential to change the mainstream discourse and view of the opioid crisis.

As a research scientist at the British Columbia Centre on Substance Use, Dr. Boyd has worked in Vancouver’s Downtown Eastside and across Canada at the heart of the opioid crisis. She has been observing, speaking to and learning from the very individuals affected by this crisis — trying to come up with a solution.

This month on Behind the Science, Dr. Boyd highlights the challenges faced by women and marginalized individuals in the opioid crisis, and what it’s like to work in the midst of an epidemic.

How did you get into this field?

Originally I was interested in dance, visual arts and media-based work, but was always interested in social justice issues and had a hard time kind of combining my art interest with social justice issues. 

From an arts background, I moved into gender studies and knew that I had a strong interest in looking at the differences that women might experience in the world in relation to men. Also, the inequities that were coming up were always important to me, particularly for marginalized women, Black, Indigenous, women of colour, poor women, and gender diverse, transgender, and non-binary people. 

During my postdoctoral studies, I was doing arts-based research with women who use drugs. There I was looking and trying to do work about resiliency, and some of the amazing things that [women] were managing to do despite all the structural barriers that they’re facing in their everyday lives. And from there, I really enjoyed working with women who use drugs, and I was really lucky to work with community groups that were led by their members.

Now I’ve moved a bit away from the arts and more into health and medicine, and that’s just because of the focus on substance use, which has become a passion of mine. It was always a topic in my family growing up and remains important to me throughout my work. 

Could you highlight some of your most important findings or highlights from your research?

I think one of the basic things that’s important or defines my research is that we want to have equitable, accessible health care and harm reduction that actually meets the needs of people. That’s always what I’m looking to help define. Communities already know what works for them, and what doesn’t. So amplifying their voices to change those policies to better meet their needs drives my research and anything that I’ve done. 

And of course, the other biggest thing is the fact that women, men and gender diverse people experience substance use and health policies quite differently and are impacted differently. Women have to deal with criminalization and stigma, and fears around child apprehension, and racialized and gendered violence in ways that are different from cis men. Even though we already know that it seems like it continues to be siloed or under-recognized. 

My work helps to maintain the importance of seeing what the needs are of those who are underserved because our health policies around harm reduction don’t always take women and gender diverse peoples’ needs into account in a fulsome way. So the work that I did look at women and gender-diverse peoples’ access to overdose prevention sites and other new overdose prevention interventions, I think are some of the highlights.

What impact do you hope to see with your work 10 years from now? And what do you hope to see from policy changes regarding the opioid crisis in the future?

I want to see the end of preventable deaths, so I would hope that 10 years from now we would not be in an overdose crisis. That people have access to the supports that they need in order to live well, and experience not top-down, but community-led efforts. 

I think that part of that is expanding more holistic approaches that are looking at poverty, systemic racism, and criminalization. Indigenous women have very high rates of overdose compared to non-Indigenous women — that are almost equal to men. They’re also over-policed and over-surveilled. So if we don’t address our prohibitionist policies and how they intersect with colonialism and misogyny, the stigma that stems from that, housing and wage inequities, or the extra surveillance of women, then we’re not going to see a lower overdose death rate. 

Ending the criminalization of drug use is key, as it has severe repercussions on the health of women who use drugs. While access to safe, non-toxic pharmaceutical-grade drugs is a step forward, it simply is not enough.

Why is it important to have research looking at both women’s health and substance use?

Substance use and the way we deal with it, and the policies around substance use, impact women’s health. Women are more likely to hide their substance use because they experience a double stigma. 

Both men and women experience stigma related to substances. But women and gender diverse people experience greater stigma because they’re not conforming to gender norms. So poor women who have children are going to experience heightened surveillance by social services, ​​especially if they are Indigenous or a woman of colour. They’re going to experience it by law enforcement and also if they’re experiencing poverty, through housing. So that affects their health in a multitude of ways, and they may be more likely to be criminalized.

If women are more likely to hide their substance use, then they’re also at heightened overdose risk, because they might be using alone without the support of someone to help them reverse an overdose. And if they’re more likely to be second on the needle, because of gendered power dynamics that already exist in our society, that means that they’re more at risk for transmissible diseases. All of those things negatively impact women’s health.

I personally don’t think using substances is a health risk, it’s the policies around it that increase risk. The way our social and structural environment impacts women who use drugs in creating negative outcomes. 

Is there anything else you want to mention? Any inspirations for your work?

Our medical norms and research tend to stem from the male perspective — that’s the kind of society that we live in. As I mentioned, we want to ensure equitable and accessible access to all forms of health care. That’s why it’s important to me to look at diverse women’s needs. Because poor women’s needs are different from middle-class women, and racialized women’s needs are different from women who benefit from white privilege and what is going on there. What are those dynamics? And if we don’t have that kind of equitable access to health care, it doesn’t work if it’s only serving one population.

I’m very influenced by the communities and women that I work with who use drugs. Many of them are engaged in activism if they’re able to, and not everybody is, as it falls on them due to government inaction. Their expertise and knowledge, their hard work, resilience, and perseverance in the context of ongoing and constant systemic, and structural barriers that they experience — it’s very inspiring. 

Early on when I was doing a project with some women who use drugs, they documented what they do in their everyday lives, and all that they were doing. Many had to travel daily to obtain their drugs, on top of all the activist work they were doing while caring for people in their community, while also navigating poisoned drug supplies and income generation. They had this added work to deal with. Doing that work on resilience has been really important to me, but at the same time, many women that I’ve worked with over the years have passed away — it’s heartbreaking. Many of these deaths were preventable because they are the result of our flawed drug policy and ongoing structural violence. And in the midst of all that, people are persevering and doing this hard work to save lives.