For around a month, Jessica Tuttle, 31, of Toledo, Ohio was a Jane Doe. She was discovered by a friend, who called the EMTs but fled the scene because she used drugs and feared potential repercussions. At the time, Jessica was addicted to opioids — taking around $300 of heroin a day — as her life spiraled out of control. She wanted desperately to stop, for the sake of her young daughters, Isabella, then 8, and Sophia, then 6, but, in the face of abusive relationships and other hardships, drugs became her escape.
After she overdosed, she spent weeks on life support — as Jane, not Jessica. Eventually, the hospital discovered her identify and notified her parents, who had custody of her daughters.
They told the family that Jessica had a 30 percent chance of making it.
"When I did wake up, my dad was sitting there and he's sitting there crying," Jessica, who's been clean for 14 months, tells Bustle, adding that after he left, "I ended up pulling out my IVs to try and go get high. Every time the emotional stuff would come up, I would run. I didn't want to face what my life had become."
Jessica wasn't alone in her battle with opioids. Of the 20.5 million Americans aged 12 or older with a substance abuse disorder in 2015, 2 million were addicted to prescription pain relievers and 591,000 had substance use disorder involving heroin, according to the American Society of Addiction Medicine. In the first nine months of 2016, those numbers skyrocketed as overdose deaths reached a record high. The crisis has especially impacted women, who represent 35 percent of opioid deaths and are overdosing at unprecedented rates.
"It is a crisis and it is an emergency," Jessica tells Bustle. "People are definitely dying."
Between 1999 and 2015, there was a 471 percent increase in women dying of prescription painkiller overdoses, compared to a 218 percent increase for men, according to a report released last month by the U.S. Department of Health and Human Services. During those years, there was a 850 percent increase in female deaths by synthetic opioids, and heroin deaths among women increased at more than twice the rate of men.
The president coming out and saying there's a national opioid crisis is a key political win with his base, the base that elected him.
In August, President Trump declared the opioid crisis to be a national emergency, in response to recommendations made in an interim report from the President's Commission on Combating Drug Addiction and the Opioid Crisis. "The opioid crisis is an emergency, and I am saying, officially, right now, it is an emergency. It's a national emergency," Trump said at his golf club in New Jersey.
However, while the national emergency designation may seem good-willed, by beginning a process to bolster resources for federal and state governments to address the crisis, Trump's decision could in fact be devastating for women struggling with addiction.
The Dire Implications of Trump's Opioid Declaration
The government's policy recommendations are problematic because they completely ignore how opioid use disorder affects women differently than men, or how the declaration will actually assist those struggling with addiction. The national emergency could even lead to tougher law enforcement measures against female addicts, by encouraging more stringent laws and penalties against drug users.
Since his announcement, Trump has offered few details on how he will tackle the crisis, and has yet to take legal steps to formally declare the emergency. When asked for more specifics, a White House spokesperson told Bustle that, "the President instructed his administration to take all appropriate and emergency measures to confront the opioid crisis," and that "these actions are undergoing an expedited legal review."
Doug Wirth, president and CEO of Amida Care, a private, nonprofit community health plan in New York City, suspects Trump's national emergency declaration wasn't intended to address the rapid rise of female opioid addicts. Rather, he says it's linked to the dramatic increase in white males affected by the opioid epidemic. Since 2001, the number of heroin users increased fivefold, with the greatest increase in use by white males, 53 percent of whom voted for Trump in the 2016 elections, according to a 2017 study by The JAMA Network.
"The president coming out and saying there's a national opioid crisis is a key political win with his base, the base that elected him," he tells Bustle.
For women across the country, opioid addiction is a real and potent risk. They are quicker to become dependent due to chemical factors like hormones, are more likely to misuse in light of psychological or emotional distress, such as sexual abuse, and often forego treatment due to the burdens of seeking reliable child care.
And yet, these very real struggles are too often ignored: Women addicts are penalized, stigmatized, and looked down upon for turning to opioids. They are viewed as numbers, as the "addicts" Trump pledges to help through his declaration.
It's scary. I've been raped and beaten, I've been held hostage. There's been many times when people would try to coerce me into sex, and then if that didn't work force me into sex.
"There's all these punitive attitudes towards women with opioid use disorder," says Shruti Kulkarni, Policy Director of the Center for Lawful Access and Abuse Deterrence. "There is a lot of institutionalized stigma and discrimination when it comes to people with this disease, and that's I think sort of behind [Trump declaring the national emergency]."
Recommendations in the interim report include rapidly increasing treatment capacity, developing fentanyl (an opioid 50 times stronger than heroin) detection sensors and disseminating them to federal, state, local, and tribal law enforcement agencies, and expanding prevention efforts by mandating prescriber education initiatives at medical and dental schools, among others.
The report includes no mention of gender, only that the final report will incorporate a more thorough examination of, "treatment for vulnerable populations such as pregnant women, and substance-exposed infants."
"The President is considering not just the emergency authorities outlined in the report, but other potential options as well," the White House spokesperson told Bustle.
But, will Trump's declaration really help the girl on the street homeless and harassed by a drug dealer craving sex? Will it provide relief to the woman seeking treatment but who must additionally provide for her young child?
As of now, and as the administration remains hush on concrete measures to tackle the opioid crisis, particularly these gendered nuances, it's impossible to tell.
How The Crisis Affects Women
For Tracey Helton, 47, a former heroin addict who has been clean for 19 years, rock bottom was the dark underbelly of San Francisco's Tenderloin District — a world fueled by alcohol, sex, and lots of drugs.
She'll never forget being homeless, sleeping in a shopping cart, strung out on dope.
Growing up in West Chester, Ohio, an affluent suburb around 20 miles outside of Cincinnati, Tracey says there was nothing to indicate she'd eventually turn to drugs. She attended an all-girls private school and enjoyed a calm upbringing. At the age of 12, Tracey was diagnosed with depression. At 17, while having her wisdom teeth pulled, she experienced her first opioid high. It was magic.
"There was something about when they pulled my wisdom teeth and I experienced this opioid, and it really resonated with me," she tells Bustle. "I didn't really get heavy into drugs for a little while, but I was in college and had been in this abusive relationship and within three weeks of that relationship ending, I started getting heavily into drugs. I was 20 years old then."
For the next eight years, Helton's life was a blur of heavy drug use. She recalls various men injecting her with drugs that first year in California. They called it vampires making other vampires, because the men didn't want to do the drugs alone.
"It's scary. I've been raped and beaten, I've been held hostage." she says. "There's been many times when people would try to coerce me into sex, and then if that didn't work force me into sex, and that's a really common experience."
"Being from Suburban Ohio, I wasn't really prepared for that," she adds softly. "No one's prepared for how deep the spiral is."
Opioid addiction affects females in ways that differ from the male experience, due to biological differences and cultural views on gender roles. Women are more likely to experience chronic pain and use prescription opioid pain medication for longer periods and in higher doses, according to the Centers for Disease Control and Prevention. A 2011 study in the American Journal of Drug and Alcohol Abuse suggests too that women become dependent on opioids at quicker rates than men, experience more cravings, and suffer more severe emotional and physical consequences, like panic attacks, anxiety, or depression.
People are afraid to go in and get things for their reproductive needs when they're using drugs.
However, and despite these challenges, women are less likely than men to seek treatment, according to the 2011 study. Kulkarni says women face unique barriers to access treatment, from lack of child care to punitive attitudes towards mothers and pregnant women.
For instance, various laws specifically target pregnant women facing addiction — 24 states and the District of Columbia have enacted policies that consider substance abuse during pregnancy to be child abuse. Yet, only 19 states have created or funded drug treatment programs specifically targeted to assist pregnant women, according to the Guttmacher Institute, while only 10 states prohibit publicly funded drug treatment programs from discriminating against pregnant women.
Earlier this year, Tennessee even introduced a law intended to criminalize pregnant women with opioid use disorder.
"As a result, women are more hesitant to seek treatment for fear of losing custody of their children," Kulkarni explains. "Yet, there's been recent increases in the number of states passing and considering criminal prosecution laws that selectively discriminate against pregnant women with substance use disorders."
Since coming to office, Trump hasn't shied away from a tough stance on the criminal justice system, while Attorney General Jeff Session advocated for a return to the war on drugs and more stringent federal charging policies — despite such tactics leading to dramatic increases in incarceration rates. The rate of female incarcerations could only continue to escalate with the declaration, by allowing the administration to up these drug penalties and with harsher enforcement.
Between 1980 and 2014, the number of incarcerated women increased by more than 700 percent and the rate of growth for female imprisonment outpaced men by more than 50 percent, according to The Sentencing Project. In 2014, 24 percent of incarcerated women were locked up for a drug offense in state prisons, compared to 15 percent of men, while the Drug Policy Alliance reported that two-thirds of women in federal prison do time for nonviolent drug offenses.
These women are separated from their children and forced to endure disturbing conditions; they are placed in a system where the odds are stacked against them, where access to effective treatment becomes even more unattainable and the likelihood of successful reentry increasingly slim.
Tracey, however, was one of the lucky ones: after various stints in jail, abusive relationships, and those intense, short-lived spurts of euphoria from the heroin to briefly make that pain disappear, she made the decision to seek treatment. She says she's been sober ever since.
Trying To Survive As a Female Opioid Addict
Tracey says she witnessed the gendered challenges of seeking treatment firsthand while living on the streets. Out there, the stakes were higher than ever; all that mattered was evading trouble and trying to survive.
"People are afraid to go in and get things for their reproductive needs when they're using drugs. There's so much stigma about them going to see the provider and many of them end up pregnant," she tells Bustle.
Once in rehab, Tracey says her experience wasn't much better. She says lack of gender-specific services was especially problematic, especially since there were significantly more men than women at her treatment facility.
"The men would make bets to see who would sleep with the female clients there," she says. "[The treatment facility] encouraged you to get it out and be sharing in these environments, and then the men would target women specifically who shared certain vulnerabilities, and I ended up experiencing that myself."
I think women feel worse about themselves because of the things that they've done under the influence than men do. It's very hard to forgive yourself, and to not only forgive yourself but also [know] that you're worth something.
Jeanne McAlister, 84, Chief Executive Officer of the McAlister Institute, an alcohol and drug treatment provider in San Diego, says that while her program is gender-specific, similar programs across the country are few and far between. She says her institute's 22 in-patient and out-patient programs center on gender-specific curriculums, and additionally include a program that permits women addicted to opioids to live with their children while seeking treatment. "I think women are much more honest if there's not men around," she tells Bustle.
For Tracey, it wasn't until she came across an out-patient women's organization, after completing her primary treatment, and found groups specifically designed for women who had experienced sexual exploitation and trauma that she began to fully heal.
Female Solidarity And The Process of Healing
At the out-patient women's organization, Tracey says she was surrounded by women who understood her struggles. They could validate her experiences, from the harassment she faced by drug dealers who tried to sleep with her, to the self-perpetuating cycles of shame and guilt she felt after succumbing to their coercion.
"It's hard when you decide that you're going to stop using drugs to then address that in an environment where generally mixed gender is not always...," she starts to say, pausing to consider her words. "To try to find a good women's group can be a challenge, or find a therapist where you feel comfortable can be a challenge."
McAlister's desire to create gendered programming for struggling addicts served as inspiration for an in-treatment program at the McAlister Institute designed just for women.
At a certain point, I told myself: 'who's ever going to want me? I was this woman in college, I had tested out of my whole first year of college taking Advanced Placement classes in high school, like I had this great future ahead of me, and now I'm like this washed up old hoe at 25 years old — who's going to want me?
The Kiva Learning Center for Women and Children, currently home to 97 women with and without children, is a 6-month program for women battling drug and alcohol addiction. Services include supportive housing, day care and parenting classes, educational workshops, mental health counseling, domestic violence assistance, vocational training, and recovery support services.
"I think women feel worse about themselves because of the things that they've done under the influence than men do," McAlister says. "It's very hard to forgive yourself, and to not only forgive yourself but also [know] that you're worth something."
Jessica understands how difficult it can be to forgive herself. She says she still carries guilt for being separated from her three girls, Isabella, Sophia, and Kennedy, 2, while addicted.
She'll never forget when her daughter, Sophia, learned about emotions in class. For the assignment, she drew a picture: one side depicted 'happy' and the other side 'sad.' The happy side was of mother and daughter, throwing a ball back and forth. On the sad side, the image was only of Sophia, crying, the words 'no mom,' and the ball on the ground.
"You can't get any more black and white than that," says Jessica, who eventually sought treatment through the nonprofit Race for Recovery, a recovery program in Ohio. "There's that guilt: I should be there full-time, everyday, all-day [with the kids]. But, at the same time, I don't want to take on too much either, because I don't want to fall again and take them with me."
With over a year of sobriety under her belt, Jessica is optimistic about the future. While her parents still have full custody of her three daughters, she visits them on a weekly basis and is constantly communicating with her two older girls through text messages and Snapchat. She also works full-time at a cleaning company, with benefits that go beyond simply earning a paycheck — she says the job has given her the self-confidence to start and piece together the life she had always envisioned for herself.
Her goals for the future are to be a good mom, and eventually a good wife.
Today, and 19 years after beating her addiction, Tracey is married, a mother to three children, and proud recipient of not one, but two degrees: a bachelors of business administration and masters of public administration. She is also the author of The Big Fix: Hope After Heroin, a book about her journey of recovery and the unique struggles faced by women addicts.
She says measures like gender-specific, trauma-informed programming, more rehabilitation options to keep families together, longer rehab programs, and easier access to naloxone, a prescription drug that reverses the effects of opioid overdose, are critical for addressing the opioid crisis.
And, for women currently facing addiction or who may have experienced trauma or sexual abuse while using, Tracey's message is that they're not alone: support exists, from anonymous crisis lines to women's support groups — even as they submerge deeper into those dark, tantalizing grips of addiction and a way back to the light seems next to impossible.
"At a certain point, I told myself: 'who's ever going to want me? I was this woman in college, I had tested out of my whole first year of college taking Advanced Placement classes in high school, like I had this great future ahead of me, and now I'm like this washed up old h** at 25 years old — who's going to want me?' " Tracey says bluntly. "And now, I own my own home, I have three kids, I've been with the same person for 17 years. It's amazing how our perception of ourself isn't reality, but you don't see that at the time."
As the Trump administration attempts to address the opioid crisis without so much as blinking an eye to the unique experiences of women facing addiction, her advice of solidarity is more important than ever.
"We're at least two or three years behind where we should be with creating a national policy," Tracey tells Bustle, pausing to emphasize, "We are not where we need to be."