Harm Reduction: Drugs and gender
Recreational drug use can have different effects on people depending on their gender. Women may be more vulnerable to the negative effects of certain drugs due to differences in metabolism and hormonal fluctuations . Additionally, social and cultural factors can also influence patterns of drug use and access to harm reduction resources.
Social and cultural aspects
Gender-based differences in social perceptions of alcohol and drug use exist. In many societies, a man's episode of heavy drinking or other drug use is viewed more permissibly than a woman's. Women are often held "responsible or guilty" for their behavior if they consume excessively, dress provocatively or behave inappropriately.
Our society teachs women how to defend from sexual assault instead of teaching men to behave with respect. This does not mean that all men are potential aggresors neither that all women are potential victims. The idea of considering women as weak ,incapable of defending herself and innocent by definition is deeply sexist and wrong. But differences exist.
Furthermore, body searches of women in public spaces are often conducted by female police officers, and as the number of female police officers is lower than that of male officers, the chances of a body search during a routine check (traffic, party, rave, or festival) are lower. As a result, women may end up carrying drugs for their friends, which can result in accusations of "drug dealing" if the amount of substances exceeds a certain limit.
Organic and metabolic aspects
Furthermore, women may require lower doses of substances to achieve the same effects compared to men due to differences in body composition and metabolism. This highlights the need for gender-specific harm reduction strategies that are tailored to the unique needs and challenges faced by women who use drugs. Women achieve pleasurable or positive effects of drugs with lower dosages, but are also in risk of more intense, lasting adverse effects with higher dosages than men.
Alcohol: Women generally have lower levels of an enzyme called alcohol dehydrogenase , which is responsible for breaking down alcohol in the body. As a result, women may experience higher blood alcohol levels and experience the effects of alcohol more strongly than men, even when consuming the same amount of alcohol. Women are also more vulnerable to liver damage and certain cancers associated with alcohol use.
MDMA: Women may experience stronger and longer-lasting effects of MDMA than men due to differences in body composition and hormonal fluctuations. However, women may also be at higher risk for adverse effects such as anxiety and depression, especially during the post-use period. Some uncommon toxic effects (as hiponatremia, water intoxication as a result of drinking too much water under MDMA) seem more frequent in young women.
Cocaine: Women may be more vulnerable to the cardiovascular effects of cocaine, including increased heart rate and blood pressure, as well as higher rates of heart attack and stroke compared to men. Women may also be more likely to experience adverse psychological effects such as anxiety and paranoia.
Amphetamines: Women may experience more severe and longer-lasting effects of amphetamines compared to men due to differences in body composition and hormonal fluctuations. Women may also be more vulnerable to adverse psychological effects such as anxiety, depression, and paranoia.
Ketamine: There is limited research on the gender-specific effects of ketamine. However, some studies suggest that women may experience more intense and longer-lasting effects of ketamine than men due to differences in body composition and hormonal fluctuations. Women may also be at higher risk for bladder and kidney damage associated with chronic ketamine use.
Psychedelics: There is also limited research on the gender-specific effects of psychedelics. However, there are studies suggest that women may experience more intense and longer-lasting effects of certain psychedelics, such as psilocybin and LSD, due to differences in body composition and hormonal fluctuations. Women may also be more vulnerable to adverse psychological effects such as anxiety and paranoia.
Contraceptives
Contraceptives are medications that mimic female hormones produced by the body, with slightly higher potency. The most common form of contraceptives is administered orally in 21-day cycles, although there are other forms such as transdermal patches, subcutaneous implants, or vaginal rings. It is important to leave a period of 1-2 hours between taking oral contraceptives and any drug that facilitates vomiting (such as MDMA, psychedelics, ayahuasca, etc.).
In the case of vomiting or occasional forgetfulness, the pill should be taken and the treatment continued. However, if there are more than two missed pills (two or more consecutive days), another method should be used during that month (such as a condom, emergency contraception if there has been intercourse, etc.).
There is no data on significant interactions with commonly used recreational substances, and there are no known clinical cases or reports of intoxication or other problems. Therefore, combining contraceptives with the most frequent patterns of recreational drug use does not seem to increase the risks. However, it is known that some amphetamine derivatives, such as methylphenidate (Rubifen, Concerta), can increase the side effects of the contraceptive pill . It is possible that something similar may happen with speed or methamphetamine, especially with more intensive patterns of use.
Tobacco is the only drug whose combination with the contraceptive pill greatly increases the risk of serious adverse effects, such as cardiovascular pathology, venous thrombosis, etc. Many Clinical Guidelines consider tobacco use to be a contraindication for taking the pill, and its association with other risk factors (such as obesity, age >35 years, and family history) makes it an absolute contraindication. Women smokers (of any age) taking contraceptives are 10-20 times more at risk of cardiovascular disease than non-smokers.
Daily use of substances such as heroin or cocaine can lead to significant menstrual disturbances that influence the effectiveness of the contraceptive pill. Some substances can also facilitate the onset of nausea and vomiting, such as MDMA, mushrooms, and ayahuasca. As previously said, it is important to allow sufficient time (at least 1-2 hours) between taking the contraceptive pill and consuming any such substance.
Pregnancy
There is sufficient evidence that many recreational drugs can have negative effects on the fetus. Harm Reduction's philosophy is to equip people with the knowledge and skills to make their own decisions about drug use. However, in the case of pregnancy and breastfeeding, the strong advice is not to use any other drugs than prescription drugs strictly necessary, as it may involve the health of a third party.
• Alcohol consumption during pregnancy is associated with lower birth weight and an increased risk of malformations and intellectual disability. The risk is dose-dependent, and the most severe malformations tend to occur in babies of chronic alcoholics. However, occasional use of high doses of alcohol during pregnancy also increases this type of risk.
• Smoking during pregnancy is associated with lower birth weight, prematurity at birth, and an increased risk of miscarriage. Pharmacological therapies (excluding nicotine replacement therapy) are not indicated in pregnancy. Some guidelines suggest that e-cigs are less harmful than smoked tobacco for women that can not stop smoking during pregnancy
• Cannabis use during pregnancy is associated with risks similar to those of tobacco (taking into account that it is often used in mixtures) and possibly mild cognitive and maturational impairment detected in test and that dissapear in following months. There are also legends about cannabis, such as that cannabis can cause childhood leukemia, which are false. For women that cannot quit using cannabis during pregnancy, the use of a vaporizer is probably safer than smoking cannabis.
• Amphetamines (speed, methamphetamine) are associated with facial and cardiac disturbances. Because of its similar structure, MDMA is likely to carry similar risks, although these problems have been reported in regular, daily amphetamine users
• Cocaine use during pregnancy is associated with decreased foetal growth and increased risk of premature detachment of the placenta, among other conditions. Many reports of "crack babies" are metodologically weak and hyped during the Reagan era.
A relatively frequent circumstance is that a person has used drugs occasionally, in a recreational setting, during the first weeks of pregnancy, before the first missed period is noticed. It is generally understood that at this time the pre-embryo is not differentiated and the maternal-fetal circulation has not been established, so the risk of problems or malformations is probably very low. This happens in many other circumstances involving prescription drugs and, in general, occasional drug use in this period does not increase the risk of miscarriage. 10-15% of all pregnancies finish in miscarriage during the first weeks. That means that if a miscarriage appears after an occasional drug use before the woman knew she is pregnant, there is no way to prove a cause-effect relation.
In any case, once the diagnosis of pregnancy has been made, only those drugs that are strictly necessary should be used and always under medical supervision, which does not include any legal or illegal drug. Most women stop smoking tobacco, weed and using recreational drugs when they know they are pregnant.
But this is not possible in all cases. Drug use during pregnancy can be seen as an indicator of child neglect or prenatal abuse. Sometimes actions such as urine testing of the baby, monitoring by social services, and, in severe cases, removal of guardianship by court order are initiated. These situations are often justified, but excesses also occur (such as in cannabis users who are unable to quit during pregnancy). In any case , the approach to women who use drugs during pregnancy must be done without moral judgements, paternalistic attitudes or power, control and threat.
