People who identify as lesbian, gay or bisexual are more likely to misuse prescription opioids than those who identify as heterosexual — and bisexual women face a particularly high risk, according to a new nationwide study.
The study from the New York University School of Medicine, published Monday in the American Journal of Preventive Medicine, is the first to use a nationally representative sample of adults in the United States to examine sexual orientation as a risk factor for prescription opioid misuse, its authors said.
Its findings shed light on the disproportionate risks faced by members of the LGBT community amid the ongoing opioid epidemic, which resulted in nearly 50,000 overdose deaths last year, according to Centers for Disease Control and Prevention estimates.
The study’s authors said the results are consistent with other research showing that sexual minorities, particularly bisexual women, are more likely to report alcohol and substance abuse — and poorer health overall.
“I think the findings speak to the life experiences of people in society,” said lead author Dustin Duncan, an associate professor in the Department of Population Health at NYU School of Medicine. “People who have less privilege and power generally have worse health. This isn’t a fluke or a one-time finding. It tends to be systematic.”
The researchers analyzed data from about 42,800 people surveyed in the National Survey on Drug Use and Health, an annual study conducted by the Substance Abuse and Mental Health Services Administration in all 50 states and the District of Columbia.
The NYU study authors relied on data from the 2015 survey, the first year in which respondents were asked questions about sexual identity and attraction. Those who took the survey were first asked whether they considered themselves to be heterosexual, gay, lesbian or bisexual. Second, respondents were asked whether they were attracted to the opposite sex or to the same sex, and to what extent.
The survey also queried the misuse of prescription opioids, defined as using prescription pain-reliever drugs in ways that were not directed by a doctor, in both the past month and the past year.
After controlling for factors such as demographics and other drug use, the NYU team of researchers found that women who identified as bisexual were twice as likely to misuse opioids when compared with heterosexual people.
One of the study’s authors, Joseph Palamar, said he found these results particularly interesting, in part because the opioid epidemic is so often associated with men.
“Typically women are more protected against drug use,” said Palamar, an associate professor in the Department of Population Health at NYU’s School of Medicine. “It’s usually the men we worry about.”
The reasons behind these disparities are unclear and require further study, the researchers said. But Duncan, the study’s lead author, said the findings square with other research indicating that bisexual women in particular are more likely to report poor health outcomes, including, for example, problems sleeping.
Duncan attributes this trend to the “minority stress model,” the theory that members of minority groups tend to experience greater degrees of stress due to stigma and discrimination.
In this case, Duncan argued, bisexual women are a minority within a minority. They might face the stigma and discrimination associated with being a woman and a member of the LGBT community, while not belonging fully to lesbian or gay circles. These additional stressors could predispose them to increased rates of substance abuse, the authors said.
“These things together create further stress, less ability to cope and give rise to poor health,” Duncan said.
Palamar wondered whether bisexual individuals might also be more exploratory in nature, both in regard to their sexuality and their openness to trying drugs. But Duncan pushed back against that theory, arguing that the differences probably have more to do with the stress associated with their distinct life experiences.
The study notably did not take into account the experiences of the transgender and non-binary communities, as the National Survey on Drug Use and Health has not yet included a question about gender identity. The survey also did not allow for participants to respond with more fluid sexual identities, including pansexuality.
The researchers also decided not to include heroin use with the prescription drug variable, “in order to keep the results more straightforward,” according to the study.
The authors adjusted for geographic differences, such as whether a person lived in an urban versus a rural area. But it would be worth accounting for geographic disparities in future research, Duncan said.
“In counties or places that are less accepting of LGBT identities . . . I would imagine there would be a higher risk of opioid use,” Duncan said.
Palamar warned against using the findings to further stigmatize the lesbian, gay and bisexual population but said the research emphasizes the need to focus prevention efforts within these communities. The authors urged doctors, parents and educators to consider sexual orientation when screening for opioid misuse and focus on stress management within lesbian, gay and bisexual communities.
“We need to continue documenting who is at risk,” Duncan said. “This study is really the first step.”