Drug and alcohol dependence · 2026
Opioid misuse and opioid use disorder by sexual identity in U.S. adults: Findings from the 2021-2022 NSDUH.
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Schuler Megan S, Stein Bradley D
Аннотация
BACKGROUND: Sexual minority adults experience elevated rates of substance use, yet recent national data on opioid misuse, opioid use disorder (OUD), and heroin-related perceptions by sexual identity and age remain limited.
METHODS: We used pooled 2021-2022 National Survey on Drug Use and Health (NSDUH) data among heterosexual, gay/lesbian, and bisexual adults (n = 90,066; gay men n = 1312; bisexual men n = 1835; lesbian/gay women n = 1428; bisexual women n = 6389). Survey-weighted logistic regression models, stratified by sex and adjusted for sociodemographic characteristics, estimated adjusted odds of lifetime opioid misuse, lifetime heroin use, past-year opioid misuse, past-year OUD, perceived heroin risk, and perceived heroin access by sexual identity. Age-stratified models estimated disparities in lifetime and past-year opioid misuse across adulthood.
RESULTS: Bisexual women had more than twice the adjusted odds of all four opioid outcomes relative to heterosexual women (aORs=2.30-2.96), with disparities in opioid misuse evident across all age groups. Lesbian/gay women had elevated adjusted odds of lifetime opioid misuse and heroin use only. Bisexual men had higher adjusted odds of lifetime opioid misuse (aOR=2.02 [1.59-2.57]) and past-year opioid misuse (aOR=1.95 [1.38-2.76]); gay men had no significant adjusted disparities. Bisexual men and women had lower adjusted odds of perceiving great risk from trying heroin; bisexual women also had higher odds of perceived heroin access.
CONCLUSIONS: Sexual identity disparities in opioid misuse and OUD persist in national data, with particularly elevated prevalence among bisexual women. Bisexual adults may benefit from age-inclusive opioid screening and harm-reduction messaging responsive to their lower perceived heroin risk.
METHODS: We used pooled 2021-2022 National Survey on Drug Use and Health (NSDUH) data among heterosexual, gay/lesbian, and bisexual adults (n = 90,066; gay men n = 1312; bisexual men n = 1835; lesbian/gay women n = 1428; bisexual women n = 6389). Survey-weighted logistic regression models, stratified by sex and adjusted for sociodemographic characteristics, estimated adjusted odds of lifetime opioid misuse, lifetime heroin use, past-year opioid misuse, past-year OUD, perceived heroin risk, and perceived heroin access by sexual identity. Age-stratified models estimated disparities in lifetime and past-year opioid misuse across adulthood.
RESULTS: Bisexual women had more than twice the adjusted odds of all four opioid outcomes relative to heterosexual women (aORs=2.30-2.96), with disparities in opioid misuse evident across all age groups. Lesbian/gay women had elevated adjusted odds of lifetime opioid misuse and heroin use only. Bisexual men had higher adjusted odds of lifetime opioid misuse (aOR=2.02 [1.59-2.57]) and past-year opioid misuse (aOR=1.95 [1.38-2.76]); gay men had no significant adjusted disparities. Bisexual men and women had lower adjusted odds of perceiving great risk from trying heroin; bisexual women also had higher odds of perceived heroin access.
CONCLUSIONS: Sexual identity disparities in opioid misuse and OUD persist in national data, with particularly elevated prevalence among bisexual women. Bisexual adults may benefit from age-inclusive opioid screening and harm-reduction messaging responsive to their lower perceived heroin risk.