Severity of DSM-5 cannabis use disorders in a nationally representative sample of sexual minorities

Abstract

Background: Our study is the first using a national sample to examine the severity of Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) cannabis use disorder (CUD) in sexual minorities. Drawing from current literature, we expected that bisexual individuals would have the highest prevalence of CUD and the most severe form of CUD. Methods: The National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III; 2012–2013) provides a nationally representative adult sample (N = 36,309), including one of the largest samples of sexual minorities. The NESARC-III is large enough to compare subpopulations of sexual minorities on dimensions of substance use disorder severity. Results: Lesbians and gay men were more likely to report mild CUD, whereas bisexuals and respondents “not sure” of their sexual identity were more likely to report severe CUD when compared with heterosexuals. Sexual minorities and heterosexuals who reported lifetime use of medical cannabis had higher odds of having a severe CUD. Sexual minorities had significantly higher odds of lifetime medical cannabis use (adjusted odds ratio [AOR] = 2.39, 95% confidence interval [CI] = 1.42–3.66, P < .001) when compared with heterosexuals, with bisexuals having the highest odds (AOR = 2.81, 95% CI = 1.66–4.75, P < .001). Conclusions: Sexual minorities have the highest odds compared with heterosexuals of developing any CUD. Moreover, the higher rates of severe CUD among bisexuals and those “not sure” have implications for drug prevention with these particularly high-risk groups. It appears that lifetime medical marijuana use may play a role in the development of CUD, although more rigorous measures of medical marijuana use are needed to determine the nature of the relations.

Keywords:

• Cannabis
• marijuana
• sexual minorities

Author contributions

Drs. Boyd and Veliz designed the study; Drs. Boyd and McCabe conducted the literature searches; Dr. Veliz conducted the statistical analyses and assisted with data interpretation; Dr. Boyd wrote the first draft of the manuscript; and all authors contributed to the interpretation of the data and have approved the final manuscript.

Additional information

Funding

The development of this study was supported by grants R01 DA043696, R01 DA036541, R01 CA212517, and R01 AA025684 from the National Institutes of Health (NIH). This paper used limited-access data obtained from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The funders had no role in the design and conduct of the study nor the interpretation of the data. The authors take responsibility for the secondary analysis and interpretation of the data and preparing the manuscript. The content is the responsibility of the authors and does not necessarily represent the official views of NIH or the US Government.