Little is known about the prevalence and risks associated with transgender and gender diverse (TGD) persons' misuse of prescription pain relievers (PPRs). This study explores the relationship between PPR misuse and various sociodemographic identities and experiences of discrimination in health care among TGD adults.
Methods:
TGD participants (n=595) were recruited in 2018 to participate in a cross-sectional statewide trans health survey through convenience sampling. Chi-square tests of independence and logistic regressions were conducted to explore associations between sociodemographics and experiences of discrimination among persons who had ever misused PPRs, or who had misused PPRs in the past year.
Results:
Sociodemographics such as gender identity (odds ratio [OR]=0.44, p=0.01), race/ethnicity (OR=0.14, p<0.001), and sexual orientation influence TGD individuals likeliness of misusing PPRs (OR=0.40, p<0.001). Notably, those who were ever diagnosed with anxiety had a higher likeliness of having lifetime PPR misuse compared with those who were never diagnosed (OR=2.05, p=0.05), and those reporting past-year discrimination within the mental health care setting because of their gender identity were more than twice as likely to report past-year misuse than those who reported not experiencing it (OR=2.43, p=0.004).
Conclusion:
Certain subpopulations of TGD individuals may be at elevated risk of PPR misuse. It is imperative to acknowledge the impact of multimarginalized identities as well as differences across various identities and experiences within the TGD community while working to address non-PPR misuse.
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References
1.
Substance Abuse and Mental Health Services Administration. 2018. National Survey on Drug Use and Health: Lesbian, Gay, & Bisexual (LGB) Adults. Rockville, MD; 2020.
2.
McLellanAT. Substance misuse and substance use disorders: Why do they matter in healthcare?. Trans Am Clin Climatol Assoc, 2017; 128:112–130.
3.
RestarAJ, JinH, OgunbajoA, et al.Prevalence and risk factors of nonmedical prescription opioid use among transgender girls and young women. JAMA Netw Open, 2020; 3(3):e201015; doi: 10.1001/jamanetworkopen.2020.1015.
4.
BenotschEG, ZimmermanR, CathersL, et al.Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults. Drug Alcohol Depend, 2013; 132(1–2):391–394; doi: 10.1016/j.drugalcdep.2013.02.027.
5.
AustinAE, ShortNA. Sexual violence, mental health, and prescription opioid use and misuse. Am J Prev Med, 2020; 59(6):818–827; doi: 10.1016/j.amepre.2020.06.019.
6.
DayJK, FishJN, Perez-BrumerA, et al.Transgender youth substance use disparities: Results from a population-based sample. J Adolesc Health, 2017; 61(6):729–735; doi: 10.1016/j.jadohealth.2017.06.024.
7.
KeuroghlianAS, ReisnerSL, WhiteJM, et al.Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend, 2015; 152:139–146; doi: 10.1016/j.drugalcdep.2015.04.008.
8.
LiX, FuQ, ScherrerJF, et al.A temporal relationship between nonmedical opioid use and major depression in the U.S.: A prospective study from the National Epidemiological Survey on Alcohol and Related Conditions. J Affect Disord, 2020; 273:298–303; doi: 10.1016/j.jad.2020.04.047.
9.
MartinsSS, FentonMC, KeyesKM, et al.Mood/anxiety disorders and their association with non-medical prescription opioid use and prescription opioid use disorder: Longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychol Med, 2012; 42(6):1261–1272; doi: 10.1017/S0033291711002145.
10.
ZulligKJ, DivinAL. The association between non-medical prescription drug use, depressive symptoms, and suicidality among college students. Addict Behav, 2012; 37(8):890–899; doi: 10.1016/j.addbeh.2012.02.008.
11.
CrenshawK. Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Rev, 1991; 43(6):1241–1299; doi: 10.2307/1229039.
12.
ReisnerSL, PardoST, GamarelKE, et al.Substance use to cope with stigma in healthcare among U.S. female-to-male trans masculine adults. LGBT Health, 2015; 2(4):324–332; doi: 10.1089/lgbt.2015.0001.
13.
FuxmanS, ValentiM, SchneiderSK, et al.Substance use among transgender and cisgender high school students. J LGBT Youth, 2021; 18(1):40–59; doi: 10.1080/19361653.2020.1727814.
14.
MeyerIH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull, 2003; 129(5):674–697; doi: 10.1037/0033-2909.129.5.674.
15.
Evans-PolceRJ, VelizPT, BoydCJ, et al.Associations between sexual orientation discrimination and substance use disorders: Differences by age in US adults. Soc Psychiatry Psychiatr Epidemiol, 2020; 55(1):101–110; doi: 10.1007/s00127-019-01694-x.
16.
LehavotK, SimoniJM. The impact of minority stress on mental health and substance use among sexual minority women. J Consult Clin Psychol, 2011; 79(2):159–170; doi: 10.1037/a0022839.
17.
MustanskiB, AndrewsR, PuckettJA. The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. Am J Public Health, 2016; 106(3):527–533; doi: 10.2105/AJPH.2015.302976.
18.
NuttbrockL, BocktingW, RosenblumA, et al.Gender abuse and major depression among transgender women: A prospective study of vulnerability and resilience. Am J Public Health, 2014; 104(11):2191–2198; doi: 10.2105/AJPH.2013.301545.
19.
RobinsonKA, DuncanS, AustrieJ, et al.Opioid consumption after gender-affirming mastectomy and two other breast surgeries. J Surg Res, 2020; 251:33–37; doi: 10.1016/j.jss.2019.12.043.
20.
BennettDA. How can I deal with missing data in my study?. Aust N Z J Public Health, 2001; 25(5):464–469; doi: 10.1111/j.1467–842X.2001.tb00294.x.
21.
HaiderMR, BrownMJ, GuptaRD, et al.Psycho-social correlates of opioid use disorder among the us adult population: Evidence from the National Survey on Drug Use and Health, 2015–2018. Subst Use Misuse, 2020; 55(12):2002–2010; doi: 10.1080/10826084.2020.1788086.
22.
JamesSE, HermanJL, RankinS, et al.The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality; 2016.
23.
CyrusK. Multiple minorities as multiply marginalized: Applying the minority stress theory to LGBTQ people of color. J Gay Lesbian Ment Health, 2017; 21(3):194–202; doi: 10.1080/19359705.2017.1320739.
24.
LettE, AsaborEN, CorbinT, et al.Racial inequity in fatal U.S. police shootings, 2015–2020. J Epidemiol Community Health, 2021; 75(4):394–397; doi: 10.1136/jech-2020-215097.
25.
PougetER, FongC, RosenblumA. Racial/ethnic differences in prevalence trends for heroin use and non-medical use of prescription opioids among entrants to opioid treatment programs, 2005–2016. Subst Use Misuse, 2018; 53(2):290–300; doi: 10.1080/10826084.2017.1334070.
26.
KeyesKM, CerdáM, BradyJE, et al.Understanding the rural–urban differences in nonmedical prescription opioid use and abuse in the United States. Am J Public Health, 2014; 104(2):e52–e59; doi: 10.2105/AJPH.2013.301709.
27.
SwannWL, KimS, KimSY, et al.Urban-rural disparities in opioid use disorder prevention and response activities: A cross-sectional analysis. J Rural Health, 2020; 37(1):16–22; doi: 10.1111/jrh.12491.
28.
KattariSK, WallsNE, SpeerSR, et al.Exploring the relationship between transgender-inclusive providers and mental health outcomes among transgender/gender variant people. Soc Work Health Care, 2016; 55(8):635–650; doi: 10.1080/00981389.2016.1193099.
29.
KattariSK, BakkoM, HechtHK, et al.Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health, 2020; 10:100525:1–7; doi: 10.1016/j.ssmph.2019.100525.
30.
SeelmanKL, Colón-DiazMJP, LeCroixRH, et al.Transgender noninclusive healthcare and delaying care because of fear: Connections to general health and mental health among transgender adults. Transgend Health, 2017; 2(1):17–28; doi:10.1089/trgh.2016.0024.
31.
U.S. Census Bureau QuickFacts: Michigan. Available from: https://www.census.gov/quickfacts/MI [Last accessed: June2, 2022].
