Table 3.
Detailed Opioid Use Measurement and Outcomes Among LGBTQ+ Opioid-Focused Studies (n = 11)
| Authors | Year | Study aim, purpose, or goal | Opioid use assesseda
(NA = not assessed) |
Heterosexual and/or cisgender comparison group? | Key opioid-related findings | |
|---|---|---|---|---|---|---|
| Heroin use | Prescription opioid misuse | |||||
| Anderson-Carpenter et al.42 | 2020 | “The present study examines associations between sociodemographic factors and both lifetime and past 12-month pain reliever misuse among military veterans [heterosexual vs. LGB].” | NA | Lifetime Past 12 months |
Yes | Higher odds of lifetime misuse among bisexual vs. straight veterans (aOR = 3.04, 95% CI = 1.72–5.38). Higher odds of lifetime misuse among bisexual vs. straight men (aOR = 2.68, 95% CI = 1.30–5.53). Higher odds of lifetime misuse among bisexual vs. straight women. (aOR: 4.14, 95% CI: 1.65–10.37). Only bisexual vs. straight women had higher odds of past 12-month use (aOR = 3.47, 95% CI = 1.28–9.41). No differences in misuse among gay/lesbian vs. straight veterans |
| Buttram et al.43 | 2014 | “We sought to examine predictors of prescription opioid misuse among a sample of high-risk substance-using MSM in South Florida.” | Past 3 months | Past 3 months | No | Past 3-month prescription opioid misuse prevalence: 25%; heroin use prevalence: 2.9% No significant differences in past 3-month use by age or race/ethnicity. Use associated with higher odds of past 3-month prescription opioid misuse: recent binge drinking; cocaine use; drug injection; substance dependence; lifetime history of arrest. Use associated with lower odds of past 3-month prescription opioid misuse: HIV positive status. No association between demographic characteristics and prescription opioid misuse |
| Capistrant and Nakash44 | 2019 | “To address this gap in evidence of prevalence of illicit opioid use among adults by sexual identity, gender, and age, we used data from the NSDUH. We pooled 2015–2017 data among adults aged 18+ to estimate age- and gender-stratified prevalence differences between LGB and heterosexual adults.” |
Length of time since last use (past 30 days, >30 but <12 months, >12 months ago). Combined with prescription misuse into “illicit opioid use” |
Past 12 months. Combined with heroin use into “illicit opioid use” |
Yes | Significantly higher past 12-month prevalence among LGB vs. heterosexual women in the 18–25 (14.4% vs. 5.9%, PD: 8.5, 95% CI = 6.8–10.2), 26–34 (12.4% vs. 5.2%, PD = 7.2, 95% CI = 5.0–9.4), and 35–49 (9.5% vs. 4.1%, PD = 5.4, 95% CI = 2.6–8.1) age groups, but not in the 50+ age group (3.7% vs. 2.1%, PD = 1.6, 95% CI = −0.5 to 3.8). Significantly higher past 12-month prevalence among gay/bisexual vs. heterosexual men in the 18–25 (11.4% vs. 8.2%, PD: 3.2, 95% CI = 0.5–5.9) and 50+ age groups (6.0% vs. 2.8%, PD = 3.2, 95% CI = 0.3–6.0) |
| Chen et al.45 | 2019 | “The purpose of this study is to…[describe] the use of any prescription opioids that has been linked to the progressive use of injection drugs and polysubstance use regardless of whether opioids are used medically or non-medically. We examine the prevalence of prescription opioid use among YBMSM as well as the individual and network correlates of prescription opioid use among YBMSM longitudinally.” | NA | Past 12 months | No | Past 12-month use prevalence: 4.7% (4.2% weighted) Cumulative incidence: 3.6% (weighted: 4.1%). No significant differences in past 12-month use by age. Prescription opioid misuse associated with higher odds of: economic hardship, criminal system involvement, being a victim of violence, illicit drug use other than marijuana, condomless anal sex. Prescription opioid misuse use associated with lower odds of having a mother figure |
| Duncan et al.46 | 2019 | “The purpose of the current study is to examine sexual orientation (including both sexual identity and sexual attraction) differences in prescription opioid misuse and prescription opioid use disorder among a nationally representative sample of adults in the U.S.” | NA | Past 30 days Past 12 months DSM-IV criteria for opioid dependence |
Yes | Prescription opioid misuse prevalence: Past-year: Heterosexual 4.5%; Gay/lesbian 8.6%; Bisexual —12.0%; Attracted only to opposite sex—4.4%; Mostly opposite sex—9.0%, equal to both sexes—7.5%; mostly same sex—7.8%; only same sex—6.9%. Past month: Heterosexual—1.3%; Gay/lesbian—1.7%; bisexual—4.4%; attracted only to opposite sex—1.3%; mostly opposite sex—2.6%, equal to both sexes—2.6%; mostly same sex—1.8%; only same sex—1.4%. Prescription opioid use disorder prevalence: heterosexual—0.7%; gay/lesbian—.8%; bisexual – 2.2%; attracted only to opposite sex—0.7%; mostly opposite sex—1.8%, equal to both sexes—1.0%; mostly same sex—1.0%; only same sex—1.5%. Bisexual individuals: higher odds of past-year (aOR = 1.53, 95% CI = 1.20–1.97) and past-month (aOR = 1.66, 95% CI = 1.14–2.42) prescription opioid misuse vs. heterosexual individuals. Those attracted mostly to the opposite sex (aOR = 2.15, 95% CI = 1.77–2.63) or equally attracted to both sexes (aOR = 1.78, 95% CI = 1.38–2.30): higher odds of past-year prescription opioid misuse vs. those only attracted to the opposite sex. In sex-stratified analyses, associations held only for female individuals |
| Morgan et al.47 | 2020 | “We aimed to assess potential mechanisms [depression and suicidal ideation] underlying disparities in past-year prescription opioid misuse affecting SM adults in the NSDUH from 2015 to 2018.” | NA | Past 12 months | Yes | 5.5% of the whole sample (N = 169,759; sexual minority n = 11,268) reported past 12-month prescription opioid misuse between 2015 and 2018. Prevalence of opioid misuse declined for all groups from 2015 to 2018, but remained higher for sexual minority vs. heterosexual groups in 2018 (lesbian/gay: 7.9%, bisexual: 9.8%; heterosexual: 4.3%). Higher odds of past-year prescription opioid misuse among lesbian (aOR = 1.89, 95% CI = 1.50–2.38) and bisexual (aOR = 2.93, 95% CI = 2.59–3.31) vs. heterosexual women, and gay (aOR = 1.62, 95% CI = 1.28–2.05) and bisexual (aOR = 1.62, 95% CI = 1.26–2.09) vs. heterosexual men (adjusting for demographics only). After adjusting for either major depression or suicidal ideation, the strength of the association decreased but remained significantly higher for most SM vs. heterosexual groups, except bisexual men in the model adjusted for suicidal ideation. Counterfactual analyses: rates of opioid misuse among SM groups would be lower if rates of depression and suicidal ideation were decreased to levels among heterosexual people |
| Pitzer et al.48 | 2020 | “The current study examines the role of opioid-related attitudes—specifically, acceptance of misuse and risk perceptions—in relation to ever and past 6 months prescription opioid misuse by sexual orientation among a national sample of youth and young adults in the U.S.” | NA | Lifetime Past 6 months. Acceptance of misuse. Risk perception |
Yes | Prevalence of lifetime (heterosexual: 19.7%, lesbian or gay: 29.2%; bisexual: 32.6%, p < 0.001) and past 6-month (heterosexual: 7.2%, lesbian or gay: 12.5%; bisexual: 9.2%, p = 0.013) prescription opioid misuse significantly higher among sexual minority vs. heterosexual groups. Compared with heterosexual young people, lesbian/gay and bisexual young people had higher average levels of acceptance and lower average levels of perceived risk. Tobacco (aOR = 2.26, 95% CI = 1.15–4.46) and marijuana use (aOR = 2.05, 95% CI = 1.21–3.47) associated with higher odds of ever misuse among bisexual participants. Having college educated parents (aOR = 3.36, 95% CI = 1.07–10.53) and not meeting basic expenses (aOR = 3.93, 95% CI = 1.25–12.36) associated with greater odds of ever misuse among lesbian/gay participants. Greater odds of ever misuse among older vs. younger bisexual participants (age 15–17 aOR = 0.33, 95% CI = 0.13–0.84 vs. age 25–34, ref). Greater odds of past 6-month use among younger gay/lesbian (age 15–17 aOR = 6.45, 95% CI = 1.30–32.07; age 18–21, aOR = 4.82, 95% CI = 1.10–21.04); and younger bisexual (age 18–21 aOR = 2.75, 95% CI = 1.09–6.92) vs. age 25–34 (ref). No significant differences in ever or past 6-month misuse among female vs. male lesbian/gay or female vs. male bisexual respondents. No significant differences in race or ethnicity among sexual minority participants, but higher odds of ever misuse (aOR = 1.31, 95% CI = 1.04–1.67) and past 6-month misuse (aOR = 2.41, 95% CI = 1.69–3.44). Higher acceptance associated with higher odds of ever misuse among bisexual participants (aOR = 3.66, 95% CI = 1.69–7.89) and past 6-month use among lesbian/gay (aOR = 2.97, 95% CI = 1.47–6.01) and bisexual (aOR = 3.47, 95% CI = 1.98–6.08) participants. Greater risk perception associated with misuse only among heterosexual participants (aOR past 6-month use: 0.71, 95% CI = 0.60–0.85) |
| Restar et al.49 | 2020 | “We estimated the prevalence of nonmedical prescription opioid use among a convenience sample of young transgender women in 2 urban centers heavily affected by opioid addiction and misuse and identify factors associated with this use.” | NA | Lifetime use | Yes (compared opioid use prevalence/risk factors among transgender girls and young women by sexual identity) | Prevalence of lifetime prescription opioid misuse: 11.8% of transgender adolescent girls and young women (vs. 12.5% national lifetime prevalence among cisgender adolescent girls/young women). In unadjusted logistic regression models, increasing age, “other” sexual identity, history of arrest or incarceration, alcohol use disorder or other substance use disorder symptoms, forgoing mental health services because of discrimination, and cigarette smoking were all associated with greater odds of prescription opioid misuse. Black participants had lower odds of misuse vs. participants of other races. In adjusted models, cigarette smoking predicted higher odds of prescription opioid misuse (smoking month or less: aOR = 3.92; 95% CI = 1.10–13.89; smoking daily: aOR = 5.69; 95% CI = 1.87–17.33, vs. those who didn't smoke). In adjusted models, “Other” sexual identity had significantly higher odds of lifetime prescription opioid misuse vs. heterosexual (aOR = 3.69; 95% CI = 1.07–12.72) |
| Robinson et al.50 | 2020 | “In this study, we compare patient characteristics and [opioid] prescribing practices in three surgeries where patients underwent removal of large portions or all of their breast tissue [gender-affirming mastectomy/masculinizing chest reconstruction; oncologic mastectomy; mammoplasty reduction].” | NA | Proportion of pills consumed out of pills prescribed | Unclear (gender identity of breast reduction and breast cancer mastectomy patients not reported) | Patients who received gender-affirming top surgery (49%), as well as those who underwent breast reduction surgery (54%), consumed a higher proportion of pills prescribed vs. those with oncologic mastectomy (<20% of pills prescribed). Breast cancer mastectomy patients prescribed significantly less morphine vs. gender-affirming and breast reduction patients. Gender-affirming patients prescribed significantly more morphine than breast reduction patients but consumed the same amount |
| Schuler et al.51 | 2019 | “We examine LGB opioid-related disparities, relative to heterosexuals, in a national sample and characterize variation among LGB adults with respect to sexual identity and gender. We use 2015–2017 NSDUH data to examine LGB disparities in lifetime prescription pain reliever misuse, heroin use and injection heroin use; past-year opioid misuse, and opioid use disorder; and perceived heroin risk and heroin access.” | Lifetime general use Lifetime injection use Past 12-month Opioid use disorder DSM-IV criteria Ease of accessing heroin Perceived risk of use |
Lifetime. Past 12-month Opioid use disorder DSM-IV criteria |
Yes | Lifetime prevalence of prescription opioid misuse: gay men—19%; bisexual men—17%; heterosexual men—12%. Gay/lesbian women—17%; bisexual women—25%; heterosexual women—8.7%. Lifetime heroin use: gay men—2.8%; bisexual men—5.7%; heterosexual men—2.8%. Gay/lesbian women—2.6%; bisexual women—5.1%; heterosexual women—1.1%. Lifetime heroin use significantly higher among bisexual vs. heterosexual men (aOR = 1.8, 95% CI = 1.1–3.0). Lifetime injection heroin use significantly higher among bisexual vs. heterosexual women (aOR = 4.0, 95% CI = 2.7–6.1). Past 12-month prescription opioid misuse significantly higher among bisexual vs. heterosexual women (aOR = 2.4, 95% CI = 2.0–2.8); lesbian/gay vs. heterosexual women (aOR = 1.6, 95% CI = 1.1–1.2); gay vs. heterosexual men (aOR = 1.4, 95% CI = 1.0–2.0). Past 12-month OUD significantly higher among bisexual vs. heterosexual women (aOR = 2.5, 95% CI = 1.7–3.5). LGB women had lower perceived risk and more perceived heroin access vs. heterosexual women |
| Wilson et al.52 | 2020 | “We examine adolescent disparities in lifetime odds of heroin and prescription opioid misuse by sexual minority status using YRBS data.” | Lifetime | Lifetime. Past 12 months |
Yes | Lifetime prescription opioid misuse prevalence among youth: gay/lesbian (28.5%); bisexual (25.1%); heterosexual (12.5%). Prevalence of lifetime heroin use: gay/lesbian (10%); bisexual (4.1%), heterosexual (1.1%). Gay/lesbian (aOR = 1.96; 95% CI = 1.29–2.96), bisexual (aOR = 2.27; 95% CI = 1.79–2.88), and unsure youth (aOR = 1.44, 95% CI = 1.06–1.94) had higher odds of prescription opioid misuse vs. heterosexual youth. Having had both-sex sexual partners predicted significantly higher odds of prescription opioid misuse (aOR = 2.62; 95% CI = 2.10–3.25) vs. only different-sex sexual contact. Gay/lesbian (aOR = 4.84; 95% CI = 2.42–9.67), bisexual (aOR = 4.27, 95% CI = 2.39–7.63), and unsure youth (aOR = 8.20, 95% CI = 4.47–15.02) had higher odds of lifetime heroin use vs. heterosexual youth. Same-sex sexual partners and both-sex sexual partners predicted higher odds of lifetime heroin use vs. only different-sex sexual partners (aOR = 3.77; 95% CI = 1.68–8.44 and aOR = 7.44; 95% CI = 4.59–12.06, respectively) |
a
Aside from heroin and prescription opioids, no other opioids were assessed among the focused studies included in this review.
aOR, adjusted odds ratio; CI, confidence interval; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; LGB, lesbian, gay, bisexual; MSM, men who have sex with men; NA, not assessed; NSDUH, National Survey on Drug Use and Health; OR, odds ratio; OUD, opioid use disorder; PD, prevalence difference; SM, sexual minority; YBMSM, young Black men who have sex with men; YRBS, Youth Risk Behavior Survey.