Prevalence and minority-stress correlates of past 12-month prescription drug misuse in a national sample of transgender and gender nonbinary adults: Results from the U.S. Transgender Survey

Kidd, Jeremy D.; Goetz, Teddy G.; Shea, Eileen; Bockting, Walter

doi:10.1016/j.drugalcdep.2020.108474

Cited by 26 publications

(21 citation statements)

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“…Another problem was the misuse of prescription drugs, which was associated with lower self-esteem, greater discrimination based on gender identity, and increased selfreported symptoms of anxiety, depression, and somatic distress [53]. Moreover, this misuse was more frequent in binary transgender men and non-binary individuals, compared to binary transgender women [54]. Indeed, 24% of transgender women reported misuse of prescribed medications, in particular highlighting the use of analgesics (21.2%), anxiolytics (14.4%), stimulants (12.5%), and sedatives (8.7%) [53].…”

Section: Discussionmentioning

confidence: 99%

Substance Use in the Transgender Population: A Meta-Analysis

et al. 2022

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(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.

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Section: Discussionmentioning

confidence: 99%

Substance Use in the Transgender Population: A Meta-Analysis

et al. 2022

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“…13,20 In light of the increased risk of opioid addiction and dependence in this population in combination with the highly invasive nature of PIV, we are compelled to identify ways to opioid use by transwomen. 11,21 Our patient groups were very similar in sociodemographic background and health status; additionally, we found minimal preoperative opioid consumption and pain. Studies have investigated the effect of opioid-naïve status on opioid consumption in the postoperative period,…”

Section: Discussionmentioning

confidence: 54%

“…12 In addition, the prevalence of prescription drug misuse, notably opioids, may be as high as 13.5% in transwomen, as reported by the US Transgender Survey. 11 This problem is further compounded by the invasive nature of some genital-based GAS, especially penile inversion vaginoplasty (PIV). PIV is a highly invasive procedure, routinely causing significant postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Moreover, the substantial reduction in opioid utilization, more than 50% as shown by our study, in patients who were managed with NCA, may reduce rates of long-term opioid dependence and abuse in high-risk populations, such as transgender patients. 3,11 Transgender patients are part of a marginalized community that faces profuse barriers to healthcare access for gender affirmation procedures. 20 PIV is one of the many surgical procedures necessary to successfully treat gender dysphoria, promoting wellness, and improve health; however, efforts must be made to ensure that adverse health outcomes related to opioid addiction do not occur after GAS.…”

Section: Discussionmentioning

confidence: 99%

“…10 Evidence-based strategies targeted toward opioid reduction following gender affirming surgery (GAS) is sparse, despite transgender patients having increased risk of chronic opioid use postoperatively as a result of societal discrimination and disparities. 11 The issue of overprescribing by physicians may be more serious after GAS; a study of post-mastectomy opioid prescriptions revealed that transgender chest masculinization patients were prescribed more opioids than cisgender oncologic mastectomy patients. 12 In addition, the prevalence of prescription drug misuse, notably opioids, may be as high as 13.5% in transwomen, as reported by the US Transgender Survey.…”

Section: Discussionmentioning

confidence: 99%

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Minimizing opioid consumption by eliminating patient‐controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol

et al. 2021

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Background Genital‐based gender affirmation surgery is a physically demanding procedure requiring extensive postoperative pain management. However, perioperative opioid use for these procedures is relatively understudied. Objectives This study analyzes whether intravenous patient‐controlled analgesia (PCA) enhances pain control after penile inversion vaginoplasty (PIV) in the setting of enhanced recovery after surgery (ERAS) protocols, and whether non‐PCA (NCA)‐based regimens could reduce postoperative opioid use. Methods All patients undergoing PIV with ERAS protocols by a single provider from December 2018 to November 2020 were retrospectively reviewed. Patient demographics, comorbid conditions, pain scores, length of stay (LOS), and opioid usage during their hospitalization were collected. Postoperative opioid use and pain scores were compared between PCA and NCA patient cohorts. Results A total of 61 patients were included. 30 patients received intravenous PCA postoperatively, and 31 patients used NCA‐based narcotic pain control. All patients underwent ERAS protocol perioperatively. Average patient age was 34.5 years (SD 11.9) in the PCA cohort and 37.6 years (SD 11.9) in the NCA cohort (p = 0.242). Average total postoperative opioid use during hospital stay was reduced by 53.7% in the NCA cohort, with an average use of 501.6 morphine milligram equivalents (MME) (SD 410.3) among PCA patients and an average use of 232.0 MME (SD 216.5) among NCA patients (p = 0.003). Daily average pain scores for postoperative days 1 to 6 did not differ between the PCA and NCA patient groups (p > 0.05). Average hospital LOS was shorter among NCA patients, 6.2 days (SD 1.0) versus 7.3 days (SD 1.4), respectively, (p < 0.001). Discussion In combination with an ERAS non‐narcotic pain control protocol, it may be possible to reduce opioid use by more than 50% and shorten length of postoperative hospital stay among patients by implementing NCA pain management protocols. Conclusion Minimizing postoperative opioid consumption after PIV will benefit patients and their sustained well‐being.

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The “triple whammy”: Serious psychological distress, suicidal ideation, and substance misuse among transgender persons

Klein,

Washington

2023

Acta Psychologica

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Prevalence and minority-stress correlates of past 12-month prescription drug misuse in a national sample of transgender and gender nonbinary adults: Results from the U.S. Transgender Survey

Cited by 26 publications

References 50 publications

Substance Use in the Transgender Population: A Meta-Analysis

Substance Use in the Transgender Population: A Meta-Analysis

Minimizing opioid consumption by eliminating patient‐controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol

The “triple whammy”: Serious psychological distress, suicidal ideation, and substance misuse among transgender persons

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