The reasons behind the ongoing opioid epidemic remain frustratingly murky. But new research points to one previously hidden psychological trigger for this often-deadly addiction: social isolation due to sexual orientation.
The new study finds that opioid abuse is higher among gays and lesbians than heterosexuals, and that it's particularly elevated among bisexual women. These discoveries suggest that the stress of sexual-minority status—which has previously been linked to various forms of substance abuse—may leave people more vulnerable to the addictive high that opioids provide.
"Primary care providers, educators, and even parents should consider sexual orientation when assessing those at risk of opioid misuse," lead author Dustin Duncan of New York University's School of Medicine said in announcing the findings. They are published in the American Journal of Preventive Medicine.
The first-of-its-kind study used data from the 2015 National Survey on Drug Use and Health, a large survey of Americans living in all 50 states. Participants were presented with "images and names of multiple products and formulations of prescription opioid pills" and asked if they had misused any, either in the past month or the past year.
Misuse was defined as using the drug without a prescription (or using drugs prescribed to someone else); using them in greater amounts, more frequently, or for longer time periods than directed; or using them in any way not authorized by a physician.
In addition, participants indicated their sexual orientation, and whether they were attracted to the opposite sex ("mostly" or "exclusively"), the same sex, or equally to both.
The researchers found that 5 percent of heterosexual adults reported having misused opioids over the past 12 months. That rate rose to 9 percent for gays and lesbians, and 12 percent for self-identified bisexuals.
Among males, heterosexuals had the lowest rate (5.3 percent), and gays the highest (10 percent), with bisexuals in between (8.3 percent). But among females, bisexuals had by far the highest rate of opioid misuse: 13.5 percent, compared to 6.8 percent for lesbians and 3.7 percent for straight women.
Duncan and his colleagues suspect the elevated numbers reflect that minority-group members "tend to experience a greater degree of stress because of personal and vicarious experiences of stigma and discrimination," which can inspire harmful coping behaviors, including substance abuse.
Many bisexual women, they add, feel this stress particularly acutely: They experience both homophobia from straight people and disapproval from lesbian acquaintances, leaving them without "the kind of community-driven support that can alleviate stigma."
"This could explain why bisexual females had a greater likelihood for opioid misuse than their peers, even though females overall tend to have lower rates of opioid misuse and opioid-related deaths than males," Duncan and his colleagues write.
The findings suggest that anti-opioid campaigns tailored to the gay, lesbian, and bisexual communities could be highly worthwhile. Addiction is everywhere, but stress makes a person more vulnerable, and few things produce more long-term anxiety than getting the message—subtly or otherwise—that you don't belong.