High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory

Cascalheira, Cory J.; Nelson, Jessie; Flinn, Ryan E.; Zhao, Yuxuan; Helminen, Emily C.; Scheer, Jillian R.; Stone, Amy L.

doi:10.1016/j.drugpo.2023.104103

Cited by 4 publications

(1 citation statement)

References 81 publications

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“…Lesbian, gay, bisexual, transgender, queer, and other populations included in the LGBTQ community (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and substance use disorders (SUD) compared to heterosexual and cisgender populations [ 1 – 9 ]. LGBTQ+ SU disparities include higher rates of opioid use and disorders (OUD) [ 6 , 9 , 10 ], as well co-use of other substances [ 11 , 12 ] like stimulants [ 11 ], which together have significantly and steadily amplified drug overdose mortality in the U.S. over the past twenty-plus years [ 13 – 16 ]. Despite these disparities, a 2022 scoping review found limited research on opioid use and OUD among LGBTQ+ and particularly transgender populations [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Experiences of and recommendations for LGBTQ+-affirming substance use services: an exploratory qualitative descriptive study with LGBTQ+ people who use opioids and other drugs

Paschen-Wolff,

DeSousa,

Paine

et al. 2024

Subst Abuse Treat Prev Policy

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Background Lesbian, gay, bisexual, transgender, queer, and other LGBTQ populations (LGBTQ+; e.g., asexual individuals) have higher rates of substance use (SU) and disorders (SUD) compared to heterosexual and cisgender populations. Such disparities can be attributed to minority stress, including stigma and discrimination in healthcare settings. LGBTQ+-affirming SU treatment and related services remain limited. The purpose of this exploratory qualitative descriptive study was to characterize LGBTQ+ people’s experiences in SU services and recommendations for LGBTQ+- affirming care. Methods We conducted demographic surveys (characterized using descriptive statistics) and individual qualitative interviews with N = 23 LGBTQ+ people. We employed flexible coding and a thematic analysis approach to describe participants’ experiences with stigma, discrimination, and support within SU services at the patient-, staff-, and organizational-level; and participant recommendations for how to make such services LGBTQ+-affirming. We highlighted components of minority stress and mitigators of adverse stress responses throughout our thematic analysis. Results Patient-level experiences included bullying, name-calling, sexual harassment, and physical distancing from peers; and support via community-building with LGBTQ+ peers. Staff-level experiences included name-calling, denial of services, misgendering, lack of intervention in peer bullying, and assumptions about participants’ sexuality; and support via staff advocacy for LGBTQ+ patients, holistic treatment models, and openly LGBTQ+ staff. Organizational-level experiences included stigma in binary gendered program structures; and support from programs with gender-affirming groups and housing, and in visual cues (e.g., rainbow flags) of affirming care. Stigma and discrimination led to minority stress processes like identity concealment and stress coping responses like SU relapse; support facilitated SU treatment engagement and retention. Recommendations for LGBTQ+-affirming care included non-discrimination policies, LGBTQ+-specific programming, hiring LGBTQ+ staff, routine staff sensitivity training, and gender-inclusive program structures. Conclusions LGBTQ+ people experience stigma and discrimination within SU services; supportive and affirming care is vital to reducing treatment barriers and promoting positive health outcomes. The current study offers concrete recommendations for how to deliver LGBTQ+-affirming care, which could reduce SU disparities and drug overdose mortality overall.

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