Disparities in Use/Misuse of Specific Illicit and Prescription Drugs Among Sexual Minority Adults in a National Sample

Published in: Substance Use & Misuse, Volume 57, Issue 3, pages 461–471 (2022). doi: 10.1080/10826084.2021.2019776

Posted on RAND.org on February 11, 2022

by Megan S. Schuler, Rebecca L. Collins, Rajeev Ramchand


Compared to heterosexual adults, lesbian, gay, and bisexual (LGB) adults have higher rates of any illicit drug use and any prescription drug misuse, yet disparities regarding specific drugs remain poorly characterized.


We examined disparities by sexual identity and sex for 8 illicit and prescription drugs using 2015–2019 National Survey on Drug Use and Health data. Outcomes included past-year use/misuse of cocaine/crack, hallucinogens, inhalants, methamphetamine, heroin, prescription opioids, prescription stimulants, prescription tranquilizers/sedatives, and level of polydrug use/misuse (2 substances; 3+ substances). For each outcome, odds ratios relative to heterosexual adults of same sex were estimated using logistic regression controlling for demographics; significant estimates were interpreted as a disparity.


Among gay men, significant disparities were present for all drugs except prescription stimulants and heroin; inhalant use was particularly elevated. Bisexual women exhibited significant disparities for every drug examined, as did bisexual men (except heroin). Among lesbian/gay women, disparities were only present for prescription opioids and stimulants. Relative to heterosexual peers, use of 3+ substances was 3 times higher among gay men and bisexual women and 2 times higher among bisexual men.


Consistent with minority stress theory, prevalences of illicit and prescription drug use/misuse were 2–3 times higher among LGB adults than heterosexual adults. Illicit drug use should not be perceived as only impacting gay/bisexual men—bisexual women had similar—or higher—prevalences of hallucinogen, cocaine, methamphetamine, and heroin use. Yet, in contrast to bisexual women, lesbian/gay women did not exhibit disparities for any illicit drugs.

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