Opioid and substance use disorders (SUDs) disproportionately affect sexually and gender diverse (SGD) populations compared to their cisgender and heterosexual counterparts. Research consistently shows that lesbian, gay, bisexual, transgender, queer, and other SGD individuals experience higher rates of substance use, misuse, and SUDs, including opioid use disorder (OUD).
A recent study from Michal McDowell, MD MPH and researchers from Mass General Psychiatry, including Abigail Batchelder, PhD, MPH, and senior author Alex S. Keuroghlian, MD, MPH, provides important insights into the differences in OUD treatment among SGD and non-SGD populations. Utilizing electronic health record data from a federally qualified health center, the researchers examined OUD diagnoses and treatment patterns among 1,133 adults with a documented OUD diagnosis (between January 2013 and June 2021).
Key Findings from the Study
Prevalence of OUD: Lesbian/gay patients had the lowest prevalence of OUD (1%), while bisexual patients had the highest (1.7%). There was no statistically significant difference in OUD diagnosis between transgender and gender diverse (TGD) patients (1.5%) compared to cisgender patients (1.4%).
Medication-Assisted Treatment: Compared to sexually diverse patients, straight/heterosexual patients were more likely to be prescribed buprenorphine (44.3% vs. 34.7%), methadone (13.8% vs. 9.4%), and naloxone (47.0% vs. 38.9%). Cisgender patients were more likely to receive buprenorphine prescriptions compared to TGD patients (40.9% vs. 31.6%). However, TGD patients were more likely to be prescribed oral naltrexone (19.7% vs. 7.0%).
Treatment Modalities: Straight/heterosexual patients had the lowest proportion of patients receiving pharmacotherapy, individual psychotherapy, addiction and group therapy, case management, and complementary care visits. They had the highest proportion of outpatient medical visits (68.4%). Transgender men had the highest proportion of individual therapy visits(80.8%), compared to genderqueer/ nonbinary patients (53.7%), transgender women (51.4%), cisgender men (40.7%), and cisgender women (40.6%). Cisgender men and women had lower rates of individual therapy visits.
Moving Forward
These findings highlight significant disparities in OUD treatment between sexually and gender diverse and non-SGD populations. The lower rates of medication-assisted treatment (MAT) prescriptions, particularly buprenorphine, in SGD patients is of great concern, given that MAT is considered the gold standard for OUD treatment. Higher rates of individual therapy among TGD patients suggest a potential preference for or greater access to this form of treatment within this population; however, provider recommendations may also play a role in determining what treatments patients ultimately receive.
Continued research on OUD treatment outcomes and experiences among SGD populations is needed to inform evidence-based interventions. “Our research highlights the urgent need for tailored interventions that consider the unique experiences of SGD people with OUD,” notes study lead author Michal McDowell, MD, a Child Psychiatry Fellow and Researcher at The Fenway Institute. “By understanding disparities in buprenorphine prescribing in particular, we can implement practice delivery changes to address this challenge. Additionally, we can consider where SGD patients feel most at home receiving OUD care and offer services tailored accordingly.”
Read More
McDowell MJ, Miller AS, King DS, Gitin S, Allen AE, Yeo EJ, Batchelder AW, Busch AB, Greenfield SF, Huskamp HA, Keuroghlian AS. Opioid Use Disorder Treatment in Sexually and Gender Diverse Patients: A Retrospective Cohort Study. J Clin Psychiatry. 2024 Oct 30;85(4):23m15185.
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.
