(25) Clinical Characteristics Differences Between Sexual Minorities and Heterosexuals with OUD

Background & Introduction: The purpose of this study is to examine how clinical outcomes and baseline characteristics differ between sexual minority and heterosexual patients with opioid use disorder (OUD). While research focusing on OUD in the LGBTQ+ community remains limited, existing studies have found higher rates of substance use and worse treatment outcomes in sexual minority populations. Minority stress may be a contributing factor in many cases, and sexual minority patients with OUD may report discrimination from peers and treatment staff. The results of this project will inform clinical practice for providers working with sexual minority patients with OUD.

Methods: This study analyzed data from electronic health records (EHR) collected by providers at four inpatient addiction treatment facilities in Maryland from December 2020 and November 2021. Data from patient records was retained for analysis if there was a diagnosis of OUD, resulting in a final sample of N= 1,461 admission records. Patients with multiple admissions during the lookback window were retained as distinct admission records. Data were extracted by research staff according to data dictionaries from History and Physical (H&P) and other provider notes, and staff performed quality assurance checks to identify and correct any inconsistencies in data extraction. A combination of descriptive (means, percentages, and standard deviations) and inferential (t-tests and χ2 tests) statistics was used to determine if there were differences on key clinical variables by sexual orientation. The clinical variables of interest comprised baseline demographic characteristics (age, gender, race/ethnicity), baseline severity characteristics (MOUD preference, history of MOUD, lifetime anxiety, depression, and suicide attempts), and treatment outcomes for the residential treatment episode (successful treatment completion, length of stay, and discharged on MOUD). Admission records with incomplete data were dropped from the analyses. Participant data for this study were de-identified, and the research was deemed exempt from IRB review.

Results: Across 1,256 admissions, 1,169 (93.07%) patients identified as heterosexual, and 87 (6.93%) identified in a way other than heterosexual (lesbian, gay, bisexual, other, or prefer not to say), which we termed sexual minority patients. Sexual minorities were more likely to be younger than heterosexual patients, with a mean age of 33.4 for sexual minority patients, and 38.6 for heterosexual patients (t= -4.8411, p< 0.0001). Sexual minority patients were significantly more likely to be female (59% female among non-heterosexuals vs 23% female among heterosexuals; χ2 = 54.45; p< 0.0001). Sexual minority participants differed from heterosexual participants in terms of race (non-white, black, Hispanic, other; χ2= 17.77, p= 0.0001); an additional analysis showed that Hispanic patients were significantly less likely to identify as heterosexual. Regarding baseline clinical characteristics, sexual minority patients were significantly more likely to have attempted suicide in their lifetime (42.5% vs 15.2% of heterosexuals; χ2= 42.55; p< 0.0001), and were more likely to report lifetime anxiety (80.2% vs. 69.6% of heterosexuals; χ2= 4.37; p= .037), but were no more likely to report lifetime depression than heterosexual patients (79.3% vs 70.2% of heterosexuals; χ2= 3.23; p= 0.072). Examining whether patients preferred initiation of MOUD during their treatment episode, there was no significant difference in the preferences of heterosexual and sexual minority patients (79.2% vs 83.3% of heterosexuals; χ2= 0.8; p= 0.371); likewise, there was no significant difference between past MOUD use in sexual minorities and heterosexual patients (80.2% vs 79.7%; χ2= 0.02; p= 0.904). Finally, an analysis of treatment outcomes revealed that sexual minority patients were significantly less likely to have successfully completed treatment (49% vs 62%, χ2= 5.38; p= .020) compared to heterosexual peers, and were significantly more likely to have a shorter treatment length of stay than heterosexual patients, with a mean of 14.2 days in treatment for sexual minority patients, and 17.1 days for heterosexual patients (t= -2.7766; p= 0.006), but there was no difference in rates of being discharged on MOUD (46% vs 50.5%; χ2= 0.67; p= 0.414).

Conclusion & Discussion: This study highlights significant differences between sexual minority and heterosexual patients with OUD in residential treatment settings. Sexual minority patients were younger, more likely to be female and Hispanic, and reported higher rates of lifetime anxiety and suicide attempts compared to their heterosexual peers. These baseline individual difference variables may contribute to the observed disparities in treatment outcomes, particularly the lower rate of successful treatment completion and shorter duration of treatment among sexual minority patients. These indicators of treatment disengagement could also be explained by other barriers, such as minority stress or discrimination, that could impact their engagement with care. These findings underscore the need for culturally competent approaches in treating sexual minority individuals with OUD. Although sexual minority patients disengaged from treatment prematurely compared to heterosexual peers, we did not find differences in rates of leaving residential treatment on MOUD, another important treatment outcome. This may suggest that sexual minority patients are more open to taking MOUD, but there could be other explanatory variables at play. Future research should investigate the role of minority stress and discrimination in residential treatment engagement for OUD and explore targeted interventions to improve outcomes for sexual minority patients in addiction treatment settings.

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