Understanding gender as it relates to drug use and drug use disorders is a critical requirement to developing effective policy and practice responses. This study aims to explore the gender dimension of non-medical use of prescription drugs (NMUPD) in Europe and the Mediterranean region and continues to build on the corpus of knowledge on the subject and also help identify gaps.

Results
The literature review identifies women as a high risk category for NMUPD and shows how gender is not predictive in the same direction across different drug categories. It highlights how the telescoping phenomenon is evident for females in their NMUPD career path and that females manifest different patterns of use then males. It highlights how trauma and interpersonal violence may be causal factors for NMUPD among women.

The submitted data indicates that in the general population, the use of prescription drugs is higher for females than for males. Prescription drug use increases with age, with the 30’s constituting a risk period. No conclusions about gender influences on the use of a class of prescription medication were reached.

While rates for prescription drug use have been shown to be clearly higher for women, the picture for NMUPD is less clear. Few countries reported on NMUPD: Greece and Lithuania register higher levels for females while the opposite is true for Lebanon and Israel. The initiation into NMUPD is marginally later for females than for males. The most common source of prescription medication for both males and females is a licit one (from a doctor), followed by ‘from a friend or a relative’ indicating the relative ease of diversion. Youth survey data indicate that rates of NMUPD for lifetime are higher for females in a number of countries and age of onset coincides with middle adolescence.

In Germany and Serbia the number of fatal overdoses related to the use of psychotropics is higher for females than for males. The data on treatment is too limited to make any reliable conclusions according to gender.

Disparity in the type of drug use surveyed in relation to prescription drug use and NMUPD makes comparison of prevalence rates particularly problematic. This does not allow for a clear documentation of the full extent of NMUPD and does not allow researchers to highlight gender differences. Data collection instruments such as general population drug prevalence surveys, do not always distinguish between ‘medical use’ and ‘non-medical use’. The national data concerning the use and misuse of medicines among general populations should, therefore, be interpreted very cautiously. Not all the countries in the survey report on the source of the prescription drugs. While the monitoring of prescribing practices among young people is an important area of research, youth surveys in Europe mainly explore NMUPD.

All countries have legislation in place to control prescription drugs (psychotropics). Not all participating countries have a system in place to register the number of prescriptions for psychotropic substances and were unable to provide data in this regard. Participating countries reported a number of scientific studies on NMUPD. Most participating countries reported that the issue of NMUPD was addressed in their country’s National Drugs Policy.

Recommendations
For monitoring and research:
The report recommends the Permanent Correspondents of the Pompidou Group to undertake the following actions:
• Ask researchers in their respective member states to contribute to the development of monitoring systems of general population drug use in those European and Mediterranean countries where they do not exist (with technical advice from the EMCDDA).
• Recommend to researchers in their respective countries that in addition to the use of ‘sedatives and tranquillisers’, the use of other categories of prescription medication be included as items in General Population Surveys.
• Ask researchers in their respective countries to ensure that the item on the source of the prescription medication is included in General Population Surveys as a core item.
• Ask researchers in the Member States to develop mechanisms for the monitoring of the Emergency Department indicator.
• Ask the EMCDDA to include, in the common core general population survey, items relating to the use 11
• of prescription medication and to the non medical use of prescription medication and that the defining and reporting on the extent of NMUPD becomes a priority.
• Ask the EMCDDA to develop a clear method of distinguishing the monitoring of both prescription practices and NMUPD.
• Ask the ESPAD to expand the categories of prescription drugs monitored and to consider including ‘prescription drug use’ not only ‘use without a prescription’.

For practice (prevention and treatment):
The report recommends the Permanent Correspondents of the Pompidou Group to undertake the following actions:
• Ask Member States to offer differentiated responses to the different needs of women in relation to prevention, harm reduction and treatment.
• Ask Member States to develop guidelines for prescription practices that, while securing that individuals who need psychotropic medication, for the relief of pain, for example, have access to it, this does not result in unnecessary prescription and potential diversion of controlled substances.
• Ask Member States to develop educational programs targeted towards patients on how to safely use, store and dispose of prescribed medicines.
• Ask Member States to train medical practitioners to be able to screen and identify those individuals who are at risk of dependence to hinder movement along the addictive career.

For policy:
The report recommends the Permanent Correspondents of the Pompidou Group to undertake the following actions:
• Ask Member States to develop coherent policies that also address the use and misuse of prescription medications and make specific reference to gender.
• Ask Member States to commission studies dedicated exclusively to NMUPD and addressing such specific issues as the initiation, escalation, physical and psychosocial consequences in relation to women as an ‘at risk’ category.
• Ask Member States to develop state level prescription drug monitoring programs.
• Ask Member States to develop educational programs targeted towards patients on how to safely use, store and dispose of prescribed medicines.

After consultation by the PG Secretariat, the Gender Equality Commission Secretariat suggests:
• Further exploration of the relationship between experiences of physical, sexual and psychological violence and NMPUD.
• Asking Member States to hold a round table bringing together international organisations active in the field to present their practices/good examples on this issue.
• Asking Member states to commission a study on the relationship between violence against women and NMPUD.