Understanding the gender dimension of drug use and drug use disorders is a critical requirement in developing effective policy and practice. A ground-breaking study by the Council of Europe’s Pompidou Group investigates women’s use of prescription drugs for non-medical reasons, i.e. women who have been prescribed a medication by a doctor but are continuing to use it without the doctor’s approval, OR they have obtained the medication from somebody else, not an authorised prescriber.1

The authors of the study define ‘non-medical use of prescription drugs’ (NMUPD) as ‘the use of a prescription drug, whether obtained by prescription or otherwise, other than in the manner or for the time period prescribed, or by a person for whom the drug was not prescribed. ‘Use’ of prescription drugs is defined as ‘consumption with doctor’s prescription and/or consumption as prescribed by a medical practitioner’.

The aims of the study are to:

• explore gender differences in NMUPD in Europe and the Mediterranean region through a documentation of secondary sources, with the aim of constructing a snapshot of the current scenario;
• identify gaps in the data available; and
• make recommendations for further research, for policy development and practice.

Following a literature review, a survey questionnaire was developed and administered to respondents in 17 countries: Cyprus, Czech Republic, Egypt, France, Germany, Greece, Ireland, Israel, Italy, Lebanon, Lithuania, Malta, Morocco, Serbia, The Netherlands, Tunisia and Wales (see map).

Findings

The literature review shows that women are a high-risk category for non-medical use of prescription drugs, and that the pattern of use is different among men and women; the pattern of use and non-medical use varies according to the category of prescription medication; and trauma and interpersonal violence may be causal factors leading to non-medical use of prescription drugs among women.

The data submitted by the 17 countries show that, in the general population, the use of prescription drugs is higher among females than among males. Prescription drug use increases with age: the report highlights the Irish data which shows that the 30s are the highest risk period. Only six of the 17 countries could report on non-medical use of prescription drugs, and Ireland is not one of them. As a result, the full extent of NMUPD across all jurisdictions cannot be known and gender differences cannot be detected. Data collection instruments such as general population drug prevalence surveys do not always distinguish between ‘medical use’ and ‘non-medical use’, and not all countries report on the source of prescription drugs. While the monitoring of prescribing practices among young people is an important area of research, youth surveys in Europe mainly explore NMUPD.

Recommendations A selection of the recommendations made on foot of the investigation to the Permanent Correspondents of the Pompidou Group, including the Irish Permanent Correspondent, to implement in their own countries, are noted below.

Monitoring and research

• Recommend to researchers that in addition to the use of ‘sedatives and tranquillisers’, the use of other categories of prescription medication be included as items in the general population survey.
• Ask researchers to ensure that the item on the source of the prescription medication be included in the general population survey as a core item.
• Ask researchers to develop mechanisms for the monitoring of emergency department visits and admissions. Currently in Ireland only emergency hospital admissions owing to misuse of prescription medications are recorded and not visits to emergency departments. As a result, the morbidity, as distinct from mortality, associated with use and non-medical use of prescription medications, is under-recorded.
• Ask the European Monitoring Centre on Drugs and Drug Addiction (EMCDDA) to include, in the common core general population survey, items relating to the use of prescription medication and to the non-medical use of prescription medication, and that the defining and reporting on the extent of NMUPD become 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’ and not just ‘use without a prescription’. 

Practice (prevention and treatment)

• Offer differentiated responses to meet different needs of women in relation to prevention, harm reduction and treatment.
• Develop educational programmes for patients on safe use and disposal of prescribed medicines.
• Develop guidelines for prescribing practices that reduce unnecessary prescriptions and the potential for diversion.
• Train doctors to identify those at risk of dependence in order to hinder their movement along the addictive career path.

Policy

• Develop coherent policies that address the use and misuse of prescription medications and make specific reference to gender.
• Commission studies dedicated exclusively to NMUPD and address specific issues such as the initiation, escalation, physical and psychosocial consequences in relation to women as an ‘at risk’ category.
• Develop state-level prescription drug monitoring programmes.
• Develop educational programmes targeted towards patients on how to safely use, store and dispose of prescribed medicines.

Violence against women and NMPUD

• Having reviewed the findings of the literature review on the possible links between trauma and interpersonal violence and NMUPD among women, the Gender Equality Commission Secretariat of the Council of Europe calls on all member states to go further – to hold round-tables bringing together international organisations active in the field to present examples of their good practice, and to commission studies on the relationship between violence against women and NMPUD.  

1. Clark M and expert working group and participants (2014) The gender dimension of non-medical use of prescription drugs (NMUPD) in Europe and the Mediterranean region [P-PG/Gender (2014) 8] https://www.drugsandalcohol.ie/22964/