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

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