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According to the OWH report, which reviewed dozens of studies about gender differences and opioid use to examine prevention, treatment, and recovery strategies for women, those who use the drugs often have histories of physical or sexual trauma. At CCHP, there is a primary care office where providers can prescribe buprenorphine, which, along with methadone, is a main form of medication-assisted treatment. There is also a methadone clinic a few floors away.

But to receive such treatment, CCHP places expectations on the patients to prioritize their mental health.

CCHP has group therapies for survivors and for pregnant and parenting women, as well as a group called Healing Circle. Shannon Graves works at Elizabeth Gregory Home in Seattle, which offers services for women who are experiencing homelessness or a substance use disorder. She says she was first prescribed opioids after she broke her arm while horseback riding, when she was just 12 years old.

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That one prescription kicked off a year-long struggle with opioids, Graves, who is now 24, says. She recalls smoking OxyContin with friends when she ran out of Vicodin. At age 15, she was introduced to heroin, and she says used the drug for seven years. Graves celebrated her second year of sobriety in April. She tells Bustle she believes her opioid use disorder would have started no matter how the substance made its way to her, though.

It was American Behavioral Health Systems ABHS , a treatment center that Graves went to in Spokane, Washington, that helped her recover by focusing not just on her opioid use disorder, but her mental health as well. I was just so alienated from the rest of the world, and it was really cool to see some of the skills that they taught us in there. Not only is sexual abuse correlated with substance use disorders, but the likelihood of being sexually abused is also substantially higher for women than it is for men.

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Nabila El-Bassel , PhD, DSW, a professor at Columbia University's School of Social Work who has done research on women and opioids, tells Bustle the lifetime rate of intimate partner violence reported by women who misuse substances is much higher than the national rate. In the context of relationships and substance misuse, she says physical and sexual violence is a huge issue.

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For women who are survivors of sexual assault, CCHP has a survivors group where the counselor uses the Seeking Safety model , an evidence-based approach that does not require participants to relive their traumatic experiences. El-Bassel has also researched the experiences of women who misuse substances and engage in sex work. Sex work can be a means of survival for some women who are using opioids, but it can also lead to retraumatization.

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Women who repeatedly experience trauma may cope by continuing to misuse drugs to escape, El-Bassel says. She believes that prevention of violence like this should begin well before a person experiences a substance use disorder. Teaching young kids and teens about violence and gender inequality is critical in preventing the abuse many women who use opioids have faced.

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