Opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment needs of transgender and gender diverse adults

Jaclyn M W Hughto; Arjee J Restar; Hill L Wolfe; Lily K Gordon; Sari L Reisner; Katie B Biello; Sean R Cahill; Matthew J Mimiaga

doi:10.1016/j.drugalcdep.2021.108674

Opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment needs of transgender and gender diverse adults

Drug Alcohol Depend. 2021 May 1:222:108674. doi: 10.1016/j.drugalcdep.2021.108674. Epub 2021 Mar 18.

Authors

Jaclyn M W Hughto¹, Arjee J Restar², Hill L Wolfe³, Lily K Gordon⁴, Sari L Reisner⁵, Katie B Biello⁶, Sean R Cahill⁷, Matthew J Mimiaga⁸

Affiliations

¹ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Department of Epidemiology, School of Public Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912, United States; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States. Electronic address: Jaclyn_Hughto@Brown.edu.
² Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, United States.
³ Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, United States; Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road (152), Building 70, Bedford, MA, 01730, United States.
⁴ Warren Alpert School of Medicine, for Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
⁵ The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; General Medicine, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, United States; Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States; Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States.
⁶ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Department of Epidemiology, School of Public Health, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States; Center for Promotion and Health Equity, Brown University, Box G-121-8, Providence, RI 02912, United States; The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States.
⁷ The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; Bouve College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States.
⁸ The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, United States; Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States; Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California Los Angeles, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States; UCLA Center for LGBTQ Advocacy, Research & Health, BOX 951772, 71-267 CHS, Los Angeles, CA, 90095, United States. Electronic address: mmimiaga@ph.ucla.edu.

Abstract

Background: Limited research has explored risk factors for opioid pain medication misuse, concomitant substance misuse, and the unmet behavioral health treatment (BHTx) needs of transgender and gender diverse (TGD) adults.

Methods: In 2019, TGD adults (N = 562) in Massachusetts and Rhode Island were purposively recruited and completed a psychosocial and behavioral health survey (95 % online; 5% in-person). Multivariable logistic regression was used to examine factors associated with past 12-month opioid pain medication misuse and unmet BHTx needs.

Results: Overall, 24.4 % of participants were trans women; 32.0 % trans men; and 43.6 % were non-binary. Past-year substance misuse included: marijuana (56.8 %), hazardous drinking (37.5 %), hallucinogens (9.8 %), benzodiazepines (8.2 %), and opioid pain medication (8.0 %). Among participants with past-year substance misuse and BHtx need (n = 326), 81.3 % received BHtx and 18.7 % had unmet BHtx needs. Being a trans woman, having HIV, stigma in healthcare, and number of substances misused were associated with increased odds of past-year opioid pain medication misuse; high social connectedness was associated with decreased odds of opioid pain medication misuse (p-values<0.05). Younger age, stigma in healthcare, and misusing opioid pain medications were associated with increased odds of unmet BHTx needs; post-traumatic stress disorder and family support were associated with decreased odds of unmet BHtx needs (p-values<0.05).

Conclusions: Addressing disparities in opioid pain medication misuse among TGD people requires systematic improvements in healthcare access, including efforts to create TGD-inclusive BHtx environments with providers who are equipped to recognize and treat the social and structural drivers of TGD health inequities, including opioid pain medication misuse.

Keywords: Behavioral health; Opioid; Pain medication; Substance misuse; Substance use; Transgender.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Analgesics, Opioid / adverse effects
Female
Humans
Male
Opioid-Related Disorders* / drug therapy
Opioid-Related Disorders* / epidemiology
Pain / drug therapy
Prescription Drug Misuse*
Substance-Related Disorders* / drug therapy
Substance-Related Disorders* / therapy
Transgender Persons*

Substances

Analgesics, Opioid

Abstract

Publication types

MeSH terms

Substances

Grants and funding