It is generally understood that pain experience and opioid abuse have relied on male-dominated models. However, sex and gender play a role in both pain experience and opioid use disorder. Using the previously validated Texas Tech University Health Sciences Center Sex and Gender Specific Health PubMed Advanced Search Tool, the authors used pertinent literature to develop this literature-based commentary on sex and gender differences in pain experience and opioid use disorder. Women report their experience of pain more frequently, have increased rates of diagnoses related to pain, have increased pain sensitivity, and have a variable response to pain and analgesia. This variable response is due to anatomic, physiologic, hormonal, psychological, and social factors that differ by sex and gender. Women have been found to be at greater risk for opioid abuse in all age groups. This may be due to the differences in pain experience, as well as sex and gender differences in prescribing patterns, cultural norms, and the increased likelihood to experience dependency and withdrawal. Approaches to the treatment of opioid use disorder are also subject to sex and gender differences-an area in need of further investigation.

Introduction The Toxicology Investigators Consortium (ToxIC) database, created in 2010 by the American College of Medical Toxicology (ACMT), compiles data recorded by medical toxicologists. In January 2017, the data field for transgender (and if transgender, male-to-female or female-to-male) was added to the ToxIC form. Little is known regarding trends in poisonings among transgender patients. We sought to review consultations managed by a bedside toxicologist and provide descriptive data in trends among types of exposures within the transgender demographic. Methods A retrospective ToxIC database evaluation of cases in which the patient identified as transgender were reviewed from January 2017-June 2019 and descriptive demographics reported. ResultsThe registry contained 113 cases that involved transgender patients. Of those with complete data, 41 (36.6%) were maleto-female, 68 (60.7%) were female-to-male, and 3 (2.7%) identified as gender non-conforming. Of those with complete data, the most common reason for encounter was intentional use of a pharmaceutical drug (N = 97, 85.8%), of which 85 (87.6%) were classified as intentional pharmaceutical use intended for self-harm. Analgesics were the most common class of drugs used out of those reported (N = 24, 22%). Forty-six (90.2%) patients aged 13-18 with complete data were identified as encounters due to selfharm. Attempt at self-harm was the most common reason for intentional pharmaceutical encounter among the sample of transgender patients with complete data (N = 85, 87.6%); with female-to-male patients having an N = 53 (77.9%). Conclusion Among transgender patients in the ToxIC registry,themost commonprimaryreasonfortheencounter was intentionaluse of a pharmaceutical drug intended for self-harm. In this small cohort, there were some age and transition differences in prevalence. These findingsmayinformpoisoningpreventionpracticesaswellassex-andgender-basedmanagementofpatientsinthisvulnerablepopulation.

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