LGB adults are at greater risk than heterosexual adults for opioid use disorder.
A report released by the National LGBT Health Education Center focuses on the reasons that members of this community are at higher risk and ways to address this major disparity. It notes that this higher prevalence of substance use disorders, including opioid use disorder, can be understood through a minority stress model. Minority stress, the everyday discrimination and marginalization that can impact an individual’s coping strategies and psychological processes, may lead some members of the LGBTQ community to turn to opioids and other substances to provide relief, and this behavioral coping strategy may then in turn impact mental and physical health outcomes.
In medical settings, LGBTQ patients also seem to be exposed to opioids at disproportionate rates. The National LGBT Health Education Center report, citing data from the Massachusetts Behavioral Risk Factor Surveillance System, says that “58% of sexual and gender minority respondents between 35-44 years of age report ever being prescribed an opiate by a medical professional, compared with just 35% of their sexual and gender majority counterparts.” This may be a result of specific clinical situations that LGBTQ adults face, such as post-surgical pain management from gender affirmation surgeries or treatment for chronic pain (which many older patients living with HIV experience).
The traditional practice for treating opioid use disorder in LGBTQ patients, as with all patients, is medication assisted therapy (MAT) in combination with counseling and behavioral health interventions. With this specific community however, certain issues must be addressed–for example, the possible interactions between MAT and hormone therapy, antiretroviral therapy (ART), or PrEP. Providers should note that, while there are noted interactions of some opioid agonists and ART medications, co-prescription of these medications is safe with appropriate monitoring and follow up; providers can refer to resources like McCance-Katz’s 2005 article in Clinical Infectious Diseases to learn more.
The National LGBT Health Education Center report also notes that providers should, in recognition of the frequent co-occurrence of substance use disorder and posttraumatic stress disorder, provide trauma-informed care. This includes training for staff, screening patients for trauma history and resulting behaviors of posttraumatic stress, and linking patients to resources.
You can access the National LGBT Health Education Center report “Addressing Opioid Use Disorder among LGBTQ Populations” here: https://www.lgbthealtheducation.org/wp-content/uploads/2018/06/OpioidUseAmongLGBTQPopulations.pdf
You can access “Treatment of opioid dependence and coinfection with HIV and hepatitis C virus in opioid-dependent patients: the importance of drug interactions between opioids and antiretroviral agents” in Clinical Infectious Diseases here: https://www.ncbi.nlm.nih.gov/pubmed/16265622
