The tragic drug or alcohol-related death of a renowned celebrity or athlete often leaves many unanswered questions. The term “Jane Crow” reflects the author’s belief that female pornography actresses are marginalized within the industry and society in terms of disorder and drug overdose deaths, which could be prevented with proper screening and intervention. The main objective of this review is to demonstrate, through an analysis of data from audio, electronic, and written sources, presented both narratively and graphically that female pornography actresses are at risk of substance use disorder and opioid overdose deaths. A secondary objective is to provide supporting biological and clinical data as a foundation for understanding why female adult actresses are at risk for substance use disorder and potential opioid overdose deaths. The final objective is to discuss the opioid risk tool and other tools and interventions to screen for substance use disorder and to mitigate the harm of illicit and legal drugs. Medical and psychological professionals should lead the charge in mitigating identification and treatment programs for substance use disorder within the pornography industry to assist in preventing drug overdose deaths among its participants.