Substance use disparities by sexual identity among a treatment-seeking population: Analyses of Irish routine health data

Background

Disparities in substance use among sexual minority (SM) persons are evidenced in population surveys internationally, but evidence from treatment surveillance is lacking. Using routinely collected treatment data, the study examines substance use behaviours among SM cases accessing substance use treatment in Ireland, with comparative analyses of non-SM cases. Clinically relevant differences may exist between SM (lesbian, gay, bisexual) persons seeking treatment and their non-SM (heterosexual) counterparts. There may also be differences in substance use among SM subgroups based on gender and sexual identify. Routine data are not yet collected at EU level and similar studies are not common outside of the US.

Methods

Data on referrals to drug and alcohol treatment from 2016 to 2023 were obtained from the National Drug Treatment Reporting System (n > 150,000). Demographic characteristics and substance use behaviours (primary substance, route of administration, age of onset, and frequency of use) are presented descriptively by SM status (SM or heterosexual), and by gender (excluding transgender cases) for sexual identity subgroups. Logistic regression analyses will determine if SM status predicts categorical substance use outcomes. Further regression models will examine differences by sexual identity subgroup, with analyses run separately by gender (female and male). Adjusted odds ratios will also be estimated accounting for demographic and psychosocial variables (ethnicity, education, and socioeconomic status). Differences in age of onset of primary substance use will be examined using multiple regression. 

Results

These analyses will reveal any significant disparities in the substance use outcomes of interest between SM and non-SM cases and among cases based on sexual identity and gender. 

Conclusion

These routinely collected data provide a unique opportunity to advance understanding of substance use disparities for SM populations. The insights from this analysis can be instrumental in developing strategies to effectively mitigate or eliminate these disparities. Further, findings can inform policy and the design and delivery of treatment services that are both inclusive and responsive to the needs of SM persons who use drugs.