PORTSMOUTH, Ohio — Prescription pain pill addiction was originally seen as a man's problem, a national epidemic that began among workers doing backbreaking labor in the coal mines and factories of Appalachia. But a new analysis of federal data has found that deaths in recent years have been rising far faster among women, quintupling since 1999.
More women now die of overdoses from pain pills like OxyContin than from cervical cancer or homicide. And though more men are dying, women are catching up, according to the analysis by the Centers for Disease Control and Prevention. And the problem is hitting white women harder than black women, and older women harder than younger ones.
In this Ohio River town on the edge of Appalachia, women blamed the changing nature of American society. The rise of the single-parent household has thrust immense responsibility on women, who are not only mothers, but also, in many cases, primary breadwinners. Some who described feeling overwhelmed by their responsibilities said they craved the numbness that drugs bring. Others said highs made them feel pretty, strong and productive, a welcome respite from the chaos of their lives.
"I thought I was supermom," said Crystal D. Steele, 42, a recovering addict who said she began to take medicine for back pain she developed working at Kentucky Fried Chicken. "I took one kid to football, the other to baseball. I went to work. I washed the car. I cleaned the house. I didn't even know I had a problem."
Ms. Steele, now a patient at the Counseling Center, a rehabilitation center here, remembers getting calls about deaths of high school classmates while working at an answering service for a local funeral home. She counted about 50 women she had known who had drug-related deaths. She believes that had it not been for a 40-day stint in jail for stealing pain pills, she would have been among them.
"I felt like I sold my soul somewhere along the way," said Ms. Steele, whose father was an alcoholic and abusive. "I didn't feel like I deserved to be given a second chance. I thought my kids would be better off without me."
For years, drug overdose deaths in the United States were seen as mostly an urban problem that hit blacks hardest. But opioid abuse, which exploded in the 1990s and 2000s and included drugs like OxyContin, Vicodin and Percocet, has been worst among whites, often in rural places. The C.D.C. analysis found that the overdose death rate for blacks in 2010, the most recent year for which there was final data, was less than half the rate for whites. Asians and Hispanics had the lowest rates.
According to the report, 6,631 women died of opioid overdoses in 2010, compared with 10,020 men.
While younger women in their 20s and 30s tend to have the highest rates of opioid abuse, the overdose death rate was highest among women ages 45 to 54, a finding that surprised clinicians. The range indicates that at least some portion of the drugs may have been prescribed appropriately for pain, Dr. Nora Volkow, director of the National Institute on Drug Abuse, said in an interview. If death rates were driven purely by abuse, then one would expect the death rates to be highest among younger women who are the biggest abusers.
Deaths among women have been rising for some time, but Dr. Thomas R. Frieden, the C.D.C. director, said the problem had gone virtually unrecognized. The study offered several theories for the increase. Women are more likely than men to be prescribed pain drugs, to use them chronically, and to get prescriptions for higher doses.
The study's authors hypothesized that it might be because the most common forms of chronic pain, like fibromyalgia, are more common in women. A woman typically also has less body mass than a man, making it easier to overdose.
Women are also more likely to be given prescriptions of psychotherapeutic drugs, like antidepressants and antianxiety medications, Dr. Volkow said. That is significant because people who overdose are much more likely to have been taking a combination of those drugs and pain medication.
Broader social trends, like unemployment, an increase in single-parent families, and their associated stressors, might have also contributed to the increase in abuse, but they are slow moving and unlikely to be a direct explanation, Dr. Volkow said.
Stella Collins, who runs group therapy sessions at the Counseling Center, said her patients, most of whom are poor, feel trapped. They are squeezing a living out of tiny paychecks. Many get no financial support from the fathers of their children and come from families where alcohol or drugs were abused. Their feelings of inadequacy and shame over not properly caring for their children help drive their addictions, she said.
"Poverty is depression, it's failure, it's sadness, it's low self-esteem," said Ms. Collins. Her mother, an addict, died of a heart attack at age 56 after spending money meant for heart medication on pain pills, she said.
"These women are stuck, emotionally and financially," Ms. Collins added.
But some of the women also fight their way back.
Kathy Newman, 35, who started using pills in her 20s, after her older sister overdosed, and whose oldest son was born addicted, has been drug-free for two years. She now takes classes, and travels around the county telling her story at schools.
For Ms. Steele, the most motivating image is that of her 12-year-old son's face streaked with tears, looking at her through the glass of the prison visiting area. Her eldest son now has custody of him.
"I was at a big stop sign and it was like, 'O.K., which way are you going to go?' " she said.
Portsmouth has worked hard to stop addiction. Easy access to prescription pain pills has been shut down. Mothers of dead addicts give talks at schools. And while Ohio's death rate from overdoses, like the national rate, is still climbing, the rate in Scioto County, where Portsmouth is located, has declined in recent years, according to the city health department.
Ms. Collins works with women in group sessions, teaching them how to like themselves again.
"Watching them die is the hardest part," Ms. Collins said. "You sit in this room and you don't know who's going to make it."