Opioid Use Disorder Treatment in Sexually and Gender Diverse Patients: A Retrospective Cohort Study

Michal J. McDowell, MD, MPH; Amitai S. Miller, BA; Dana S. King, ALM; Sy Gitin, BS; Avery E. Allen, BA; Ellis J. Yeo, BA; Abigail W. Batchelder, PhD, MPH; Alisa B. Busch, MD, MS; Shelly F. Greenfield, MD, MPH; Haiden A. Huskamp, PhD; Alex S. Keuroghlian, MD, MPH

J Clin Psychiatry 2024;85(4):23m15185

Abstract

Objective: This study assesses differences in opioid use disorder (OUD) treatment among sexually and gender diverse (SGD) vs non-SGD people.

Methods: Using electronic health record data from a federally qualified health center, this retrospective cohort study explores OUD treatment for adults with an OUD diagnosis, as well as any clinic visit from January 2013 until June 2021 (N = 1,133), through review of medication prescriptions for OUD and OUD-related visits.

Results: Patients identifying as lesbian/gay had the lowest prevalence of OUD, with 1% (n = 231) of lesbian/gay patients having an OUD diagnosis, as compared to 1.5% (n = 560) of straight/heterosexual patients, 1.7% (n = 108) of bisexual patients, 1.4% (n = 44) of patients who identified as “something else,” 1.6% (n = 26) of patients who “don’t know” their sexual orientation, and 1.6% (n = 164) of patients who did not report their sexual orientation (P < .0001). There was not a statistically significant difference (P = .49) between OUD diagnosis in the transgender and gender diverse (TGD) cohort (1.5%, n = 117) and the cisgender cohort (1.4%, n = 1016). Straight/ heterosexual patients were more likely than sexually diverse patients to be prescribed buprenorphine (44.3%, n = 248 vs 34.7%, n = 133, P = .003), methadone (13.8%, n = 77 vs 9.4%, n = 36, P = .04), and naloxone (47.0%, n = 263 vs 38.9%, n = 149, P = .01). Cisgender patients were more likely to be prescribed buprenorphine than TGD patients (40.9%, n = 416 vs 31.6%, n = 37, P = .05). TGD patients were more likely to be prescribed oral naltrexone than cisgender patients (19.7%, n = 23 vs 7.0%, n = 71, P < .001). The straight/ heterosexual cohort had the lowest proportion of pharmacotherapy (19.3%, n = 108), individual psychotherapy (35.9%, n = 201), addiction and group therapy (12.9%, n = 72), case management (8.4%, n = 47), and complementary care visits (3.9%, n = 22). Straight/ heterosexual patients had the highest proportion of outpatient medical visits (68.4%, n = 383). Transgender men had the highest proportion of individual therapy visits (80.8%, n = 21), compared to 53.7% (n = 29) of genderqueer/ nonbinary patients, 51.4% (n = 19) of transgender women, 40.7% (n = 300) of cisgender men, and 40.6% (n = 113) of cisgender women (P < .001).

Conclusion: The disparities in buprenorphine prescriptions and in outpatient medical visit access between the SGD and non-SGD cohorts highlight important priorities for culturally responsive interventions at clinical, organizational, and systems levels.

J Clin Psychiatry 2024;85(4):23m15185

Author affiliations are listed at the end of this article.

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References (46)

Dart RC, Surratt HL, Cicero TJ, et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372(3):241–248. PubMed CrossRef
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1211–1259. PubMed CrossRef
Substance Abuse and Mental Health Services Administration. Lesbian, Gay, and Bisexual Behavioral Health: Results from the 2021 and 2022 National Surveys on Drug Use and Health (SAMHSA Publication No. PEP23-07-01-001). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2023. https://www.samhsa.gov/data/report/lgbbehavioral-health-report-2021-2022
Keuroghlian AS, Reisner SL, White JM, et al. Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend. 2015;152:139–146. PubMed CrossRef
Morgan E, Feinstein BA, Dyar C. Disparities in prescription opioid misuse affecting sexual minority adults are attenuated by depression and suicidal ideation. LGBT Health. 2020;7(8):431–438. PubMed CrossRef
Lee JH, Gamarel KE, Bryant KJ, et al. Discrimination, mental health, and substance use disorders among sexual minority populations. LGBT Health. 2016;3(4):258–265. PubMed CrossRef
McDonald K. Social support and mental health in LGBTQ adolescents: a review of the literature. Issues Ment Health Nurs. 2018;39(1):16–29. PubMed CrossRef
Hall NY, Le L, Majmudar I, et al. Barriers to accessing opioid substitution treatment for opioid use disorder: a systematic review from the client perspective. Drug Alcohol Depend. 2021;221:108651. PubMed CrossRef
Rasinski KA, Woll P, Cooke A. Stigma and substance use disorders In: Corrigan PW, ed. On the Stigma of Mental Illness: Practical Strategies for Research and Social Change. American Psychological Association; 2005:219–236.
Substance Abuse and Mental Health Services Administration. Medications for Opioid Use Disorder. Treatment improvement protocol (TIP) series 63 publication No. PEP21-02-01-002. Substance Abuse and Mental Health Services Administration; 2021.
Bell J, Strang J. Medication treatment of opioid use disorder. Biol Psychiatry. 2020;87(1):82–88. PubMed
Sofuoglu M, DeVito EE, Carroll KM. Pharmacological and behavioral treatment of opioid use disorder. Psychiatr Res Clin Pract. 2019;1(1):4–15.
Mistler CB, Shrestha R, Gunstad J, et al. Adapting behavioural interventions to compensate for cognitive dysfunction in persons with opioid use disorder. Gen Psychiatr. 2021;34(4):e100412. PubMed CrossRef
Mauro PM, Gutkind S, Annunziato EM, et al. Use of medication for opioid use disorder among US adolescents and adults with need for opioid treatment, 2019. JAMA Netw Open. 2022;5(3):e223821. PubMed CrossRef
Novak P, Feder KA, Ali MM, et al. Behavioral health treatment utilization among individuals with co-occurring opioid use disorder and mental illness: evidence from a national survey. J Subst Abuse Treat. 2019;98:47–52. PubMed CrossRef
Mackey K, Veazie S, Anderson J, et al. Barriers and facilitators to the use of medications for opioid use disorder: a rapid review. J Gen Intern Med. 2020;35(suppl 3):954–963. PubMed CrossRef
Andrilla CHA, Moore TE, Patterson DG, et al. Geographic distribution of providers with a dea waiver to prescribe buprenorphine for the treatment of opioid use disorder: a 5-year update. J Rural Health. 2019;35(1):108–112. PubMed CrossRef
Cahill S, Miller AS, Keuroghlian AS. Sexual and gender minority health equity in the biden administration. JAMA Health Forum. 2022;3(2):e214868. PubMed CrossRef
Casey LS, Reisner SL, Findling MG, et al. Discrimination in the United States: experiences of lesbian, gay, bisexual, transgender, and queer Americans. Health Serv Res. 2019;54 suppl 2(suppl 2):1454–1466. PubMed CrossRef
Substance Abuse and Mental Health Services Administration. Substance use disorder treatment for people with Co-occurring disorders. 2020. Accessed November 28, 2022. https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-01-004_Final_508.pdf
Information about medication-assisted treatment (MAT). Accessed July 18, 2023. https://www.fda.gov/drugs/information-drug-class/information-about-medicationassisted-treatment-mat
Ashley F, Brightly-Brown S, Rider GN. Beyond the trans/cis binary: introducing new terms will enrich gender research. Nature. 2024;630(8016):293–295. PubMed CrossRef
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. PubMed CrossRef
Chen LY, Strain EC, Crum RM, et al. Gender differences in substance abuse treatment and barriers to care among persons with substance use disorders with and without comorbid major depression. J Addict Med. 2013;7(5):325–334. PubMed CrossRef
Mental Health Medications. NAMI: National Alliance on Mental Illness. Accessed December 13, 2022. https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications
Stoltzfus JC. Logistic regression: a brief primer. Acad Emerg Med. 2011;18(10):1099–1104. PubMed CrossRef
Paschen-Wolff MM, Kidd JD, Paine EA. The state of the research on opioid outcomes among lesbian, gay, bisexual, transgender, queer, and other sexuality and gender-diverse populations: a scoping review. LGBT Health. 2023;10(1):1–17. PubMed
Kerr DL, Ding K, Chaya J. Substance use of lesbian, gay, bisexual and heterosexual college students. Am J Health Behav. 2014;38(6):951–962. PubMed CrossRef
Kerridge BT, Pickering RP, Saha TD, et al. Prevalence, sociodemographic correlates and DSM-5 substance use disorders and other psychiatric disorders among sexual minorities in the United States. Drug Alcohol Depend. 2017;170:82–92. PubMed CrossRef
Green KE, Feinstein BA. Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment. Psychol Addict Behav. 2012;26(2):265–278. PubMed CrossRef
Medley G, Lipari RN, Bose J, et al. Sexual orientation and estimates of adult substance use and mental health: results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review; 2016. https://www.samhsa.gov/data/sites/default/files/NSDUH-SexualOrientation-2015/NSDUH-SexualOrientation2015/NSDUH-SexualOrientation-2015.htm
Hughto JMW, Quinn EK, Dunbar MS, et al. Prevalence and Co- occurrence of alcohol, nicotine, and other substance use disorder diagnoses among US transgender and cisgender adults. JAMA Netw Open. 2021;4(2):e2036512. PubMed CrossRef
Valentine SE, Shipherd JC. A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev. 2018;66:24–38. PubMed CrossRef
Day JK, Fish JN, Perez-Brumer A, et al. Transgender youth substance use disparities: results from a population-based sample. J Adolesc Health. 2017;61(6):729–735. PubMed CrossRef
Girouard MP, Goldhammer H, Keuroghlian AS. Understanding and treating opioid use disorders in lesbian, gay, bisexual, transgender, and queer populations. Subst Abus. 2019;40(3):335–339. PubMed CrossRef
McCance-Katz EF, Sullivan L, Nallani S. Drug Interactions of clinical importance among the opioids, methadone and buprenorphine, and other frequently prescribed medications: a review. Am J Addict. 2010;19(1):4–16. PubMed CrossRef
Jokinen V, Lilius T, Laitila J, et al. Do diuretics have antinociceptive actions: studies of spironolactone, eplerenone, furosemide and chlorothiazide, individually and with oxycodone and morphine. Basic Clin Pharmacol Toxicol. 2017;120(1):38–45. PubMed
Paschen-Wolff MM, DeSousa A, Paine EA, et al. Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs. Subst Abuse Treat Prev Pol. 2024;19(1):2.
McDowell MJ, King DS, Gitin S, et al. Alcohol use disorder treatment in sexually and gender diverse patients: a retrospective cohort study. J Clin Psychiatry. 2023;84(5):23m14812. PubMed CrossRef
Duncan DT, Zweig S, Hambrick HR, et al. Sexual orientation disparities in prescription opioid misuse among U.S. adults. Am J Prev Med. 2019;56(1):17–26. PubMed
Cepeda A, Nowotny KM, Frankeberger J, et al. Examination of multilevel domains of minority stress: implications for drug use and mental and physical health among Latina women who have sex with women and men. PLoS One. 2020;15(3):e0230437. PubMed CrossRef
Parent MC, Arriaga AS, Gobble T, et al. Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress. 2019;10:100146. PubMed CrossRef
Watkins LE, Patton SC, Drexler K, et al. Clinical effectiveness of an intensive outpatient program for integrated treatment of comorbid substance abuse and mental health disorders. Cognitive Behav Pract. 2023;30(3):354–366.
Choi NG, DiNitto DM, Marti CN. Treatment use, perceived need, and barriers to seeking treatment for substance abuse and mental health problems among older adults compared to younger adults. Drug Alcohol Depend. 2014;145:113–120. PubMed CrossRef
Donald M, Dower J, Kavanagh D. Integrated versus non-integrated management and care for clients with co-occurring mental health and substance use disorders: a qualitative systematic review of randomised controlled trials. Soc Sci Med. 2005;60(6):1371–1383. PubMed CrossRef
Williams EC, Fletcher OV, Frost MC, et al. Comparison of substance use disorder diagnosis rates from electronic health record data with substance use disorder prevalence rates reported in surveys across sociodemographic groups in the veterans health administration. JAMA Netw Open. 2022;5(6):e2219651. PubMed CrossRef