Understanding and Treating Opioid Use Disorders in Lesbian, Gay, Bisexual, Transgender, and Queer Populations

Abstract

Purpose: Although little is known about the specific burden of the opioid epidemic on lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, there is evidence to suggest that opioid use disorder (OUD) is disproportionately prevalent in the LGBTQ community. We sought to conduct a literature review of OUD in LGBTQ populations and to write a clinical brief to enumerate unique clinical considerations, better understand risk reduction and treatment, provide best practices in addressing this clinical issue, and identify gaps in knowledge and next steps for distribution to primary care centers nationally. Methods: A literature review of OUD in LGBTQ populations was conducted to assess the epidemiology and interventions currently known, including the Substance Abuse and Mental Health Services Administration National Survey on Drug Use and Mental Health. This review was leveraged to frame the issue in the context of minority stress, address medical and nonmedical opioid use in LGBTQ populations, explore the complex interplay between OUD and sexual risk, and propose trauma-informed behavioral health interventions adapted specifically to this population for use in primary care and behavioral health settings. Results: Minority stress is an effective framework in which to understand OUD in LGBTQ people, who often face discrimination based on their sexual orientation or gender identity and may turn to opioids to provide relief. LGBTQ people are also prescribed opioids at higher rates than their sexual and gender majority counterparts, though the cause is not known. Opioid use has the potential to increase HIV risk via sexual and injection drug behaviors, and OUD treatment has been shown to increase safer sex and injection-drug practices. Though medication-assisted therapy remains the mainstay of treatment for OUD in this population, additional trauma-informed LGBTQ- specific adaptations of cognitive behavioral therapy and cognitive processing therapy may augment treatment efficacy. Fenway Health offers a two-pronged approach of an LGBTQ-focused integrated OUD program that may be replicated in other community health and primary care centers around the country. Conclusions: Programs that integrate behavioral health with primary care, address minority stress, and use a trauma-informed approach have the most potential to produce effective, long-term benefits for LGBTQ-identified people with opioid use disorder.