Is Sexual Orientation a Risk Factor for Opioid Misuse?

Analysis of national survey shows female bisexuals have increased risk for opioid misuse

The U.S. continues to reckon with an opioid epidemic, which was declared a public health emergency in March 2018. Since opioid misuse often precedes heroin use and has significant risks including addiction and overdose, public health officials and researchers want to understand how the epidemic affects specific population segments. For this purpose, the ongoing National Survey on Drug Use and Health (NSDUH) collects self-reported data from a nationally representative sample of populations living in households (this excludes institutionalized and incarcerated populations and people living in group arrangements like dormitories).

A new study from CDS affiliate Dustin T. Duncan, Associate Professor in the Department of Population Health, Joseph J. Palamar, Associate Professor in the Department of Population Health, H. Rhodes Hambrick, NYU Langone, and Sophia Zweig, Johns Hopkins, examines 2015 NSDUH data to determine whether sexual orientation is a risk factor for prescription opioid misuse and use disorder. This study is the first of its kind to use a nationally representative sample from the NSDUH. Similar studies of sexual minority health often rely on convenience samples, which can introduce bias.

The nationally representative data includes responses about misuse of 38 opioids during the past year and past month, and it serves as a proxy diagnosis for opioid use disorder. It also includes detailed demographic data such as questions about sexual identity and sexual attraction, which together comprise sexual orientation for the purpose of the study. For each sexual identity included on the survey (heterosexual, gay/lesbian, and bisexual), the survey has data for sexual attraction (only opposite sex, mostly opposite sex, equal for both sexes, mostly same sex, and only same sex).

Duncan and collaborators stress the importance of analyzing both types of responses, since “sexual identity may not encompass the full scope of all existing sexual minorities. By contrast, sexual attraction has been shown to capture the largest cross section of individuals.” With attention to this distinction, the researchers performed a series of statistical analyses on the data to determine correlations between opioid misuse and sexual orientation. They performed all their analyses twice — once without regard for gender and again stratified by gender.

Their results revealed that “female respondents identifying as bisexual or having attraction ‘mostly’ to the opposite sex or ‘equally’ to both sexes were especially more likely to report prescription opioid misuse or use disorder.” Additionally, indicating “mostly opposite sex” attraction was associated with increased risk for participants across all sexual identities.

While researchers can only speculate about the underlying causes of this revelation, the study indicates a clear need for further research of this population to address increased risk. But most importantly, the results of the study indicate the importance of providing proven treatment methods like methadone to sexual minority individuals, especially bisexual females. The researchers also suggest “users and potential users need to be better educated about the potential dangers associated with misuse of opioids.” Even populations who are experienced with other drugs may not be aware of the serious risks and addictive potential of opioids.

By Paul Oliver