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Sex and gender are regarded as critical structural determinants of mental health and mental illness. Mental illness is a complex phenomenon, and risky behaviour and substance use commonly occur simultaneously or subsequent to one another. A gendered vulnerability in biological, environmental, and behavioural risk factors has been registered in the development and escalation of mental illness. Studies have found that women who use drugs experience greater physical and mental health repercussions than men. Women who use drugs present higher rates of depression and anxiety, suicidal tendencies, isolation and general psychological distress. This chapter addresses the most common mental illnesses associated with women who use drugs: depression, anxiety, trauma-related disorders, and eating disorders.

This chapter examines representations of gender in online modafinil markets. While gender has often been absent from scholarship on online drug markets, our analysis demonstrates the ubiquity of gender in representations of modafinil users and sellers. The analysis draws on visual images, blogs, and marketing emails relating to three websites selling modafinil, discussed pseudonymously. We describe the range of ways that notions of gender are represented in advertising. Although women represent around 40% of that buying modafinil online, websites and communications tended not to feature women. Although sexist stereotypes of women were rarely present (in contrast to direct-to-consumer pharmaceutical advertising), the ways that modafinil was imagined tended to focus narrowly on corporate spheres of work and productivity. We contrast this narrow imaginary with female journalists’ own accounts of using modafinil to manage illness and enhance creativity. Thus, we conclude that the ways that modafinil has been imagined reflects working assumptions as to who is considered the ‘normal’ participant in online modafinil markets.