Prescription Drug Misuse, other Substance Use, and Sexual Identity: The Significance of Educational Status and Psychological Distress in US Young Adults

Abstract

Background The aim was to examine the effects of sexual identity, educational status, and their interaction on the past-year prevalence of controlled prescription use and prescription drug misuse (PDM) in U.S. young adults, 18–25 years. Methods Data were from the 2015–2017 National Survey on Drug Use and Health (young adult N = 38,298). Past-year prescription opioid, stimulant and benzodiazepine use and PDM were outcomes, with PDM defined as use without a prescription or in ways not intended by the prescriber. Separate regressions by sex evaluated the relationship between prescription medication use or PDM prevalence and sexual identity, educational status/attainment (college student/graduate versus non-college), their interaction and past-year psychological distress. Results Sexual identity minority young adults had higher rates of prescription use and PDM than heterosexual young adults. After accounting for educational status, though, bisexual men rarely differed from heterosexual men; after including psychological distress, gay men rarely differed from heterosexual men. Versus heterosexual women, lesbian (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [95% CI] = 1.47–2.30) and bisexual (AOR= 1.78, 95% CI = 1.27–2.50) young adult women had higher rates of prescription opioid misuse, after adjusting for educational status, psychological distress and sociodemographics. Versus heterosexual men, benzodiazepine PDM was elevated in gay men (AOR = 1.91, 95% CI= 1.02–3.58). Educational status was generally associated with lower rates of prescription use and PDM, except for stimulant PDM. Conclusions Screening for psychological distress and PDM is needed in sexual identity minority young adults, especially for prescription opioid misuse among sexual identity minority women. Culturally-sensitive intervention should be considered for those with elevated psychological distress or signs of PDM. Further research on the sex differences found in the link between psychological distress and sexual identity minority opioid and stimulant PDM is warranted.

Let’s Connect: Impact Evaluation of an Intervention to Reduce Mental Health Disparities Among People Who are LGBTQ+

“…LGBTQ+ people) often suffer even worse health disparities (Quinn & Dickson-Gomez, 2016;Quinn et al, 2017;Robertson et al, 2021), and thus intersectionality was an underlying theme of the Let's Connect intervention by design, and our results suggest this was an important feature. Mental health interventions specific to LGBTQ+ people are sorely needed, as LGBTQ+ people continue to have persistent risk factors for suicide (Transgender Law Center, 2012), substance use (Batchelder et al, 2021;Diaz et al, 2021;Klare et al, 2020), and poor health outcomes for HIV (Dorcé-Medard et al, 2021), cancer (Fuchs et al, 2021;Junejo & Sheikh, 2021), and hepatitis C (Deacon et al, 2013;Wang et al, 2021). This is especially true for those on the fringes of the LGBTQ+ community, such as those with less mainstream identities (such as being bisexual or having another less-well-recognized sexual orientation, or being trans or gender non-conforming), and those who were unhoused or unstably housed (Batchelder et al, 2021).…”

How a “Something Else” Response Option for Sexual Identity Affects National Survey Estimates of Associations Between Sexual Identity, Reproductive Health, and Substance Use

“…These measures (with possible values in parentheses) included: Current marital status (married vs. not married), along with number of times married (0, 1, 2,…; Kerridge et al, 2017 ); Family formation, including household size (1, 2, 3, …) and an indicator of currently living with at least one child under the age of 18 (yes/no; Weber, 2008 ); Current pregnancy status (yes/no; Charlton et al, 2020 ; Everett et al, 2017 , 2019a ); Current use of various types of contraceptives (e.g., condoms; yes/no, for each type; Charlton et al, 2013 , 2019 ); Current sexual activity without contraceptive use (yes/no, for those sexually active; Charlton et al, 2013 , 2019 ); Intention to have children in the future (yes/no; Shenkman & Abramovitch, 2021 ); Measures of current substance use, including past-month binge drinking; past-year cigarette smoking, including at the rate of a pack-per-day; marijuana use; and other illicit drug use (e.g., cocaine, crack, and crystal meth) (yes/no; Boyd et al, 2019 ; Drabble et al, 2021 ; Klare et al, 2021 ); Risky sexual behaviors, including number of current sex partners (0, 1, 2,…) and anal sex (ever/never; Parmenter et al, 2020 ; Ueda et al, 2020 ); and Measures of sexual health, including sexually transmitted diseases (ever had an STD/never had an STD, and past-year STD (yes/no); Gurnik et al, 2023 ; Everett et al, 2019a , 2019b ). …”

“…Measures of current substance use, including past-month binge drinking; past-year cigarette smoking, including at the rate of a pack-per-day; marijuana use; and other illicit drug use (e.g., cocaine, crack, and crystal meth) (yes/no; Boyd et al, 2019 ; Drabble et al, 2021 ; Klare et al, 2021 );…”

“…A large body of research has presented evidence of significant differences in the prevalence of adverse health outcomes among subgroups of individuals defined by sexual identity (NASEM, 2020 ). Individuals who identify as sexual minorities (e.g., lesbian, gay, bisexual) have repeatedly been shown to be at higher risk of substance use disorders (Boyd et al, 2019 ; Klare et al, 2021 ; McCabe et al, 2009 ), psychopathology (e.g., mood disorders) (Bostwick et al, 2010 ; Denney et al, 2021 ; Garbarski, 2021 ), suicidality (Denney et al, 2021 ; Haney, 2021 ), and risky sexual behaviors (Charlton et al, 2021 ; Gurnik et al, 2023 ; Macapagal et al, 2021 ). Sexual minorities have also been shown to be at higher risk of discrimination (Casey et al, 2019 ; Denney et al, 2021 ; McCabe et al, 2010 ).…”

Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress

“…In line with the minority stress framework, a recent study has analyzed the odds of prescription drug misuse in sexual minorities in regression models with and without a psychological distress variable among young adults (18–25 years old) 17 . They found that past-year psychological distress accounted for a considerable share of the differences between individuals from sexual minorities and their heterosexual counterparts, suggesting that psychological distress might act as a confounder in the higher odds of prescription drug misuse among individuals belonging to sexual minorities.…”