Opioid misuse and opioid use disorder by sexual identity in U.S. adults: Findings from the 2021-2022 NSDUH.

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.