Substance use disorder treatment in sexually and gender diverse people

Michal McDowell, MD, MPH

MGH/McLean Adult Psychiatry Residency Training Program – Resident
Michal McDowell poster

Scientific Abstract

Background: The purpose of this study is to assess differences in substance use disorder (SUD) treatment among sexually and gender diverse (SGD) versus non-SGD populations.

Methods: This is a retrospective cohort study using data from an electronic health record (EHR) system at a community health center specializing in SGD care. The inclusion criteria are adults with diagnostic codes in the EHR for alcohol use disorder and/or opioid use disorder (AUD and OUD) and any type of clinic visit during the study period (January 2011–June 2021). SUD psychopharmacology treatment was assessed for AUD and OUD, including naltrexone, acamprosate, and disulfiram, as well as naltrexone, buprenorphine, methadone, and naloxone, respectively.

Results: Regarding diagnoses for AUD and OUD, significant differences were found among SGD categories. For AUD, 6.9% of patients (1,533) identifying as lesbian/gay carried the diagnosis, whereas only 2.6% of patients (975) identifying as straight/heterosexual did. Among patients who identified as straight/heterosexual, 1.5% (560) were diagnosed with OUD, while only 1.0% (231) identifying as lesbian/gay were. For gender identity, cisgender men carried the highest rates of both AUD and OUD diagnosis, with 6.1% (2,483) and 4.9% (2001), respectively. There were no differences in AUD psychopharmacology prescribing between SGD and non-SGD communities excepting oral naltrexone, with 1.0% (320) of the sexually diverse cohort as compared to 0.3% (96) of the straight/heterosexual cohort. For OUD psychopharmacology prescribing, we saw significant differences in sexual orientation group receipt for all prescriptions, with the straight/heterosexual group having higher rates of buprenorphine/buprenorphine naloxone, methadone, and naloxone prescriptions and the sexually diverse group having a higher rate of oral naltrexone prescription. For gender identity OUD psychopharmacology group differences, transgender and gender diverse folks received more oral naltrexone prescriptions as compared to cisgender folks.

Conclusions: Significant differences exist in SUD diagnoses, as well as treatment utilization, in an SGD cohort as compared to a non-SGD cohort.

Live Zoom Session – March 9th

research Areas


Michal McDowell, MD, MPH, Dana King, ALM, Sy Gitin, Abby Batchelder, PhD, MPH, Alisa Busch, MD, MS, Shelly Greenfield, MD, MPH, Haiden Huskamp, PhD, Alex Keuroghlian, MD, MPH

Principal Investigator

Alex Keuroghlian, MD, MPH