Lesbian, gay, and bisexual older adults at higher risk for substance use

Middle-aged and older adults who identify as lesbian, gay, or bisexual have higher rates of using certain substances in the past year than those who identify as heterosexual, according to a new study led by researchers at NYU Grossman School of Medicine and the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU School of Global Public Health. The study is published in the Journal of General Internal Medicine.

These findings are consistent with prior studies showing that LGBTQ adolescents and young adults are more likely to use a range of substances compared to their heterosexual counterparts. Such use may be attributed to minority stressors, including discrimination, oppression, and stigma. However, further research is needed into the likely complex causes of such disparities, including the roles that stigma, discrimination, and prejudice play in substance use, especially among older adults.

"Our research confirms that a higher prevalence of substance use among lesbian, gay, and bisexual adults can continue into later life. Similar to LGBTQ adolescents and young adults, such prevalence may be related to stressors like discrimination and stigma based on sexual orientation in addition to stressors related to aging, including social isolation and age-related stigma," said Benjamin Han, MD, MPH, the study's lead author and an assistant professor in the Department of Medicine's Division of Geriatric Medicine and Palliative Care and the Department of Population Health at NYU Langone Health.

The study used data from the National Survey on Drug Use and Health, an annual survey of a representative sample of individuals in the United States, which asks questions about sexual identity, including if individuals identify as lesbian, gay, or bisexual. Using surveys from 2015 through 2017, the researchers focused on data from adults ages 50 and older to determine their past-year use of cannabis, alcohol, cocaine, and methamphetamine, as well as non-medical use of prescription opioids, sedatives (such as sleep medications), stimulants, and tranquilizers (such as anti-anxiety medications, including benzodiazepines).

Researchers then compared the prevalence of past-year substance use among adults in the cohort identifying as lesbian, gay, or bisexual to those identifying as heterosexual. The sample included 25,880 participants with 2.5 percent identifying as lesbian, gay, or bisexual.

The researchers found that middle-aged and older adults identifying as lesbian, gay, or bisexual were more likely to use various substances studied than were heterosexual adults. Specifically, older sexual minority adults were more than twice as likely to use cannabis nonmedically (13.9 percent vs. 5.5 percent), twice as likely to use prescription tranquilizers nonmedically (3.6 percent vs. 1.1 percent), and more likely to use prescription opioids nonmedically (4.7 percent vs. 2.3 percent) than were older heterosexual adults.

"These findings should inform prevention and harm reduction efforts in this community and should not be used to stigmatize such individuals. We hope that this new research, published during Pride Month, will remind people about the stressors many people still face in 2020 based on their sexual orientation," said CDUHR researcher Joseph Palamar, PhD, MPH, the study's senior author and an associate professor in the Department of Population Health at NYU Langone Health. "Even though times are changing and things have been getting better for the LGBTQ community, older individuals in this population may still be affected from past experiences of intolerance."

Substance use adds complexity to caring for older adults, who are undergoing physical changes, are more likely to have chronic diseases, and may take more prescription medications as they age--which can interact with such substances and lead to adverse events.

"These age-related changes place older adults at increased vulnerability to the harms of substance use," said Han, who is also a CDUHR researcher. "This is even more true for vulnerable populations who experience stigma, like those identifying as lesbian, gay, or bisexual, and may already experience a range of health disparities and have barriers to accessing health care."

The researchers emphasize that the goal of this research is not to further stigmatize, but to draw attention to the needs of communities who have been underserved. They recommend the use of both patient-centered and public health approaches to prevent or reduce any potential harms associated with unhealthy substance use among older lesbian, gay, and bisexual adults.

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Mari Miyoshi of the University of Hawaii, an additional coauthor on the study, participated through NYU's Medical Student Training in Aging Research (MSTAR) Program funded by the National Institute on Aging (T35AG050998-01). This study was also funded by the National Institutes of Health's National Institute on Drug Abuse (K23DA043651 and K01DA038800).

About CDUHR

The mission of the Center for Drug Use and HIV/HCV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national, and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041). It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the NYU School of Global Public Health. For more information, visit http://www.cduhr.org.

About NYU Langone Health

NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. Included in the 260+ locations throughout the New York area are six inpatient locations: Tisch Hospital, its flagship acute-care facility in Manhattan; Rusk Rehabilitation, ranked as one of the top 10 rehabilitation programs in the country; NYU Langone Orthopedic Hospital, a dedicated inpatient orthopedic hospital in Manhattan with all musculoskeletal specialties ranked top 10 in the country; Hassenfeld Children's Hospital at NYU Langone, a comprehensive pediatric hospital, also in Manhattan, supporting a full array of children's health services; NYU Langone Hospital--Brooklyn, a full-service teaching hospital and level 1 trauma center located in Sunset Park, Brooklyn; and NYU Winthrop Hospital, a full-service teaching hospital and level 1 trauma center located in Nassau County on Long Island. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute-designated comprehensive cancer center; NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history; and NYU Long Island School of Medicine. For more information, go to nyulangone.org, and interact with us on Facebook, Twitter, YouTube, and Instagram.

About NYU School of Global Public Health

At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit: http://publichealth.nyu.edu/

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