A new study on prescription opioid misuse rates by sexual orientation confirms what earlier, less comprehensive studies suggested: Lesbian, gay and bisexual people are at a higher risk for misusing opioids, according to researchers.
But the study also raises questions about a worrisome trend in one subset in the LGBT community. If opioid abuse rates tend to be lower among women in general — and they do, researchers say — then why are bisexual women at the highest risk for misuse of any group in the study?
New York University School of Medicine researchers’ new study finds that 13.5 percent of self-identified bisexual women misused prescription opioids in the past year. Compare that to a 5 percent misuse rate among Americans who identify as straight, and a 9 percent misuse rate among those who identify as gay or lesbian, according to a news release from NYU researchers.
“Typically women are more protected against drug use,” says Joseph J. Palamar, a senior study author and associate professor in population health at NYU, according to the Washington Post. “It’s usually the men we worry about.”
The study uses 2015 data from 42,802 people who took part in the National Survey on Drug Use and Health. That year was the first that the survey asked questions about sexual attraction and orientation. The findings were published Nov. 19 in the American Journal of Preventive Medicine — and according to the authors, their research is the first to use a nationally representative sample to study how prescription opioid misuse varies by sexual orientation.
Researchers define “misuse” as using prescription opioids against doctors’ orders, with no prescription, in large quantities or for longer than prescribed.
The findings show that women who said they were bisexual were twice as likely to misuse prescription opioids when compared with those of other orientations, researcher said. While that finding diverges from the broader trend among women, it was “consistent with trends in the literature suggesting increased alcohol and substance use (such as smoking and illegal drug use) in bisexual females,” researchers write.
“With the opioid crisis escalating nationwide, it is important to focus on preventing misuse among groups at highest risk,” Palamar says in a statement.
Researchers offer a handful of potential explanations, including the “minority stress model.”
That explanation suggests that “members of minority groups tend to experience a greater degree of stress because of personal and vicarious experiences of stigma and discrimination, and that this additional stress may predispose individuals to increased rates of maladaptive coping behaviors, including substance use,” researchers write.
Bisexual men’s rate of prescription opioid misuse — 8.3 percent — was lower than the 13.5 percent of bisexual women who misused opioids in the previous year. Bisexual men were also less at risk than gay men, 10 percent of whom misused opioids over the same time period. The rate was 5.3 percent for straight men, 3.7 percent for straight women and 6.8 percent for lesbian women, according to the study.
Researchers say women who identify as bisexual could have it particularly tough, because they face homophobia from the straight community and biphobia from the lesbian community.
Stigma from many sides makes bisexual women’s stress worse, “while not providing the kind of community-driven support that can alleviate stigma and discrimination,” the authors write.
Future research will be needed to fully understand why bisexual women’s risk for prescription opioid misuse is higher, according to the study.
To solve the problem the study identifies, researchers recommend educational programs aimed at cutting misuse rates among sexual minorities.
“Primary care providers, educators, and even parents should consider sexual orientation when assessing those at risk of opioid misuse,” Dustin T. Duncan, a study author and associate professor at NYU, says in a statement.
Researchers write that they opted to exclude heroin use from the study and focus on prescription opioid misuse “to keep the results more straightforward.”
The authors also caution against using the study to stigmatize LGBT people, the Post reports.
“We need to continue documenting who is at risk,” Duncan says, according to the Post. “This study is really the first step.”