Transgender adults more likely to be diagnosed with substance use disorders

Transgender adults have a higher prevalence of substance use disorder diagnoses compared with cisgender adults, according to a study published in JAMA Network Open.

“Extensive research finds that transgender individuals experience widespread discrimination, violence and other forms of stigma due to their gender identity or expression,” Jaclyn M. W. Hughto, PhD, MPH, assistant professor of behavioral and social sciences and of epidemiology at Brown University, told Healio Primary Care. “These experiences of mistreatment result in gender minority stress and can lead some transgender individuals to misuse substances to cope with distress. Thus, it is likely that the higher prevalence of substance use disorder observed among transgender individuals in the present study is largely driven by minority stress and avoidant coping in the form of substance misuse.”

Hughto and colleagues conducted a cross-sectional analysis of data from the OptumLabs Data Warehouse, which include claims from individuals insured commercially or through Medicare Advantage in 2017 who had at least five medical claims reported that year.

Transgender adults were identified through ICD-9 and ICD-10 diagnostic codes that are specific to transgender patients, procedure codes for transgender-related surgeries and prescriptions for sex-discordant hormones.

The researchers also used ICD-10 codes to identify substance use disorder diagnoses (SUDD) for alcohol, nicotine, cocaine, cannabis and opioids.

A total of 15,637 transgender adults were included in the study and matched 3:1 with 46,911 cisgender adults based on age and geographic information.

Hughto and colleagues found significant differences in the prevalence of nicotine SUDD between transgender (16.6%) and cisgender (5.4%; P < .001) adults. They also identified a difference in the prevalence of alcohol SUDD between transgender (2.6%) and cisgender (0.9%; P < .001) adults.

Additionally, the researchers determined that transgender adults had a higher prevalence of drug SUDD (4.3%) compared with cisgender adults (1.2%; P < .001).

The most common drug SUDDs in transgender adults were cannabis (2.1%), opioid (1.3%) and cocaine (0.5%), while SUDDs in cisgender adults were equally prevalent for cannabis (0.4%) and opioid (0.4%), followed by cocaine (0.1%).

Additionally, the researchers determined that the prevalence of polysubstance SUDD was higher among transgender individuals (2%) compared with cisgender individuals (0.5%; P < .001).

“Unfortunately, prior research finds that many substance use treatment providers are unprepared to meet the needs of transgender people,” Hughto said. “Providers should engage in efforts to improve their cultural and clinical competency to care for patients with diverse gender identities and expressions.”

For instance, she said that substance use counselors should learn how “minority stress” can contribute to substance use among transgender people, and that they should work on skills to help support transgender patients with substance misuse and find health-promoting methods to cope with stigma. Finally, substance use disorder treatment facilities should work to create gender-inclusive environments, she said.

“This can include the creation of intake forms that allow patients to self-identify their gender and list their preferred name and pronouns, the posting of health education materials and other signage that feature people of diverse gender expressions, access to gender-neutral or single-stall bathrooms, and the training of all staff — front desk, nurses, prescribers, social workers and other providers — in how to provide culturally-competent and gender-inclusive care,” Hughto said.