National Institute on Drug Abuse Drug Effects and Consequences Recommendations from NIDA's Conference on Drug Addiction and the Health of Women

Gender Differences

1. Basic research, both human and animal, is needed on gender differences in the effects of psychoactive drugs. Evidence suggests that anxiety, depression, and defensive behaviors involve neurotransmitter and neuromodulatory systems that operate differently in males and females. Because these systems have important roles in drug abuse, these sex differences need to be studied thoroughly.
2. More research is needed on how different opioid receptors are affected by drugs of abuse and what sex difference may exist.
3. Few studies examine sex differences in the effects of psychoactive medications on women of childbearing age, particularly pregnant women, and how women's hormones and the menstrual cycle may influence the effects of these drugs.
4. More information is needed about gender differences in health and medical consequences.
5. Biological and behavioral mechanisms that need study include cocaine's effect on reproductive function, the effect of the estrous cycle on cocaine self-administration, gender differences in responses to serotonergic and dopaminergic neurotransmission, and gender-specific considerations in the use of psychoactive medications.

Menstrual Cycle/Reproductive Hormones

1. Research is needed on the effects of psychoactive medications on women of childbearing age, particularly pregnant women, and how women's hormones and the menstrual cycle may influence the effect of these drugs.
2. Future research needs to clarify how cocaine interacts with reproductive hormones to cause menstrual and other reproductive disorders. Among the research questions that need to be answered are (a) What is the effect of reproductive hormones influenced by cocaine on the functioning of the brain and the immune system? (b) Is the amenorrhea associated with chronic cocaine exposure a consequence of cocaine's effects on luteinizing hormones (LH), estradiol, which regulates LH release, or the regulation of prolactin? (c) What are the implications of cocaine-induced increases in LH, its possible effects on ovulation and the increased likelihood of pregnancy?
3. Research is needed on the mechanisms associated with prolactin that underlie cocaine's effects on prolactin regulation and the clinical significance of hyperprolactinemia.

Pregnancy

1. Cocaine causes an increase in the heart rate and blood pressure, but it acts to restrict the increase in blood flow. Research is needed on the vasoconstrictive properties of cocaine and resultant consequences with regard to the pregnant female and pregnancy outcome.
2. Some evidence suggests that pregnancy may predispose a woman to enhanced cardiotoxicity during pregnancy. Additional research is needed to understand how cardiotoxicity may affect pregnant women who use drugs.
3. Chronic cocaine use may reduce the effectiveness of beta-receptor agonists, the primary medications used to stop premature labor. More research is needed on the relationship of cocaine use to miscarriage and premature labor. Alternative medications to prevent premature labor need to be developed.
4. Cocaine raises fetal blood pressure and heart rate. Nonhuman animal research suggest that cocaine concentrations can be transferred from the mother to the fetus through the placenta or umbilical cord. It is not known whether amniotic fluid might act as a reservoir that potentially could expose the fetus to cocaine long after the mother has stopped using the drug. More research is needed on the effects of cocaine use on the fetus.

Stress

1. Examination of stress is a critical element in drug abuse research. Stress can be used as an independent variable to study sex differences in various responses to drugs and to reveal the underlying mechanisms of drug action.
2. Stress and cocaine use correlate, particularly with regard to drug relapse. Former heroin and cocaine addicts have been found to be hyperresponsive to chemically-induced stress. More research is needed to determine whether this hyperresponsiveness may result in relapse for these former addicts and whether gender differences exist in the interaction of drugs of abuse and stress.
3. It is critical to conduct additional research on three-way interactions, such as the interactions of sex differences and stress with alcohol, cocaine, opiates, nicotine, and other drugs. Such studies must examine sex differences at the same time they measure the effects of drug use, stress, smoking or eating. Hypotheses about the biological and behavioral interactions of drug use, stress, and sex can be developed and analyzed by using nonhuman animal models and comparing the results with information based on research with humans.
4. More research is needed to examine the suggestion that the expectancy of drug effects and the cognitive variables that affect drug action may interact with stress and have different influences on women and men.
5. Alcohol-related stress has been shown to affect men and women differently. Similar studies need to be conducted with illicit drugs.

HIV/AIDS

1. Women with HIV infection are at risk of developing a variety of sexually transmitted diseases and other gynecologic problems. Research is needed on what diseases are specific to women with HIV and how they are manifested. Clinical manifestations that are specific to women need to be investigated thoroughly, including the efficacy of new HIV therapies in treating these diseases.
2. Research is needed on how drugs of abuse affect the activity of CD4+ and CD8 cells. This information is particularly important because these cells are the first line of defense against many diseases and may be related to the progressions of AIDS.

Ethnic/Racial/Cultural Issues and Populations

Hispanics

1. Longitudinal studies among Hispanic women are needed in order to delineate the consequences of drug abuse in this population of women.
2. Data is needed on whether lack of effective interventions and sustained drug problems result in an inordinate number of Hispanic women being placed in prison.

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