Abstract
Background
Sexual and gender minorities (SGM) experience elevated rates of opioid use and overdose, yet mechanisms driving SGM overdose vulnerability remain underexamined. Utilizing a syndemics framework, this study explores how psychosocial stress and structural stigma co-occur to shape overdose vulnerability among SGM individuals who use opioids.
Methods
Cross-sectional survey data were collected from U.S.-based SGM adults reporting past-year illicit opioid use (N = 331) via Prolific-Academic. Latent profile analysis identified patterns of traumatic stress, internalized stigma, heterosexist discrimination, and state-level structural stigma. Multinomial logistic regression examined sociodemographic predictors of profile membership. BCH procedures assessed between-profile differences in overdose-related outcomes.
Results
A four-profile solution emerged (entropy=0.924): (1) low stress/low structural stigma (n=99), (2) low stress/high structural stigma (n=157), (3) high stress/low structural stigma (n=40), and (4) high stress/high structural stigma (n=35). Higher psychosocial stress (Profiles 3, 4) was associated with greater harm reduction engagement (e.g., naloxone possession, overdose response training; p<.01); lower-stress profiles (1, 2) showed higher overdose response knowledge/self-efficacy. Profile 4 exhibited higher overdose risk than Profile 3, including greater lifetime overdose frequency, heroin use severity (p<.01), and injection drug use (p<.001). Profile 4 was also associated with structural vulnerability, including food insecurity (OR = 3.91, 95% CI [2.23–6.84], p<.001), and racialized identity (OR > 50, p<.001).
Conclusions
Findings highlight a distinct pattern of overdose vulnerability in which structural stigma is associated with higher overdose risk independent of psychosocial stress and harm reduction knowledge/behaviors. Thus, structural stigma may function as an upstream determinant of SGM overdose vulnerability beyond individual-level processes.