We worked with the team at Folx Health to bring awareness to OUD treatment in the LGBTQ community.
Amid all the Pride celebrations this month, it’s essential to reflect on the disparities in health outcomes for LGBTQ+ adults — disproportionate rates of substance abuse, heart disease, and higher cancer risk, just to name a few. But one critical health inequity among the LGBTQ+ community that often goes overlooked: Research shows that sexual and gender minorities are at increased risk for opioid misuse.
The “why?” question is complicated to answer. However, it might be best to consider it within the broader context of minority stress. When discrimination, marginalization, and stigma become a fact of daily life, escaping or muting challenging emotions through the use of opioids or other substances is not a far-fetched coping strategy.
Then there are certain clinical situations that disproportionately affect LGBTQ+ people. For instance, though not all transgender people undergo surgery for gender affirmation, when they do, accompanying pain management is a factor at play. And opioids are the most prevalent form of pain management following surgery. Any surgery with opioids as pain management has a risk of tolerance/dependence and ongoing or problematic use if not managed well.
While more can and should be done to prevent the risk of opioid use disorder (OUD) in this population by addressing root causes, we also need to look closely at treatment — and how the system fails (or outright ignores) the LGBTQ+ community. Sexual orientation and gender identity can be related to a person’s treatment for OUD–yet, rarely are LGBTQIA folks’ unique needs addressed in OUD treatment.
Below are a few key things to know about addressing OUD among LGBTQ+ folks.
Medication is the gold standard treatment for OUD
Treatment for OUD might not always seem clear-cut to patients and providers. For instance, people may want to know how medications for opioid use disorder (MOUD) might interact with gender-affirming hormone therapy for transgender patients. Other common medications include antiretroviral therapy (ART) for those who have HIV, and pre-exposure prophylaxis (PrEP) for those at increased risk for HIV. This is why clinicians need to be adequately informed. The reality? As with all patients, MOUD is the gold standard of treatment for LGBTQ+ people with opioid use disorder and should be offered to all patients with OUD. While MOUD has known interactions with certain ART and hormone-modulating medications, this should not deter patients from beginning this life-saving treatment for OUD. With appropriate monitoring, it is safe to co-prescribe these medications that are both medically necessary for some people. It is also worth noting: buprenorphine is a safer medication with fewer drug-drug interactions than methadone, which is an alternate option for MOUD.
Discrimination is costing lives
A 2017 survey of nearly 500 LGBTQ+ adults by Harvard T.H. Chan School of Public Health researchers found that more than one in six people reported avoiding health care because they worried about discrimination. At the same time, more than 100,000 Americans die each year from drug-involved overdoses, mostly from opioids. Simply put: We cannot afford LGBTQ+ folks to feel hesitant about seeking lifesaving health care, such as treatment for OUD. And the change needs to start with healthcare providers — ensuring that all patients feel safe when seeking and establishing care for substance use issues.
Pushing rehab can do more harm than good
For many LGBTQ+ folks, the idea of baring their souls in group therapy in mainstream treatment centers (spaces predominantly filled with heterosexual people) can feel incredibly daunting. And understandably so. Overall, the effects of the traditional treatment setting are, at best inconsistent and, at worst harmful, especially when evidence-based pharmacological intervention with MOUD isn’t offered. Everyone, including LGBTQ+ folks, can benefit from extra psychosocial support in addition to medication, but we know that individualized care that considers each person’s unique emotional and psychosocial needs goes a lot further than one-size-fits-all therapy techniques. Evidence-based practice for LGBTQ folks seeking help for mental health and substance use issues is key.
Overall, we need to do more to validate the unique needs of LGBTQ+ people while offering care grounded in evidence-based practice.
Telehealth is a game-changer
Considering the stigma faced by the LGBTQ+ population in the traditional healthcare setting and a potential increased need for privacy, it’s easy to see how telehealth can be a game-changer. Telehealth services for patients with OUD — like the kind offered by Ophelia — address significant barriers to accessing medical care for underserved populations, including the LGBTQ+ community. We focus on maintaining and expanding access to these services to ensure that all patients feel welcome while receiving compassionate, patient-centered, and high-quality evidence-based care.
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