Prescription drug misuse, other substance use, and sexual identity: The significance of educational status and psychological distress in US young adults

Abstract

Background

The aim was to examine the effects of sexual identity, educational status, and their interaction on the past-year prevalence of controlled prescription use and prescription drug misuse (PDM) in U.S. young adults, 18–25 years. Methods: Data were from the 2015–2017 National Survey on Drug Use and Health (young adult N = 38,298). Past-year prescription opioid, stimulant and benzodiazepine use and PDM were outcomes, with PDM defined as use without a prescription or in ways not intended by the prescriber. Separate regressions by sex evaluated the relationship between prescription medication use or PDM prevalence and sexual identity, educational status/attainment (college student/graduate versus non-college), their interaction and past-year psychological distress. Results: Sexual identity minority young adults had higher rates of prescription use and PDM than heterosexual young adults. After accounting for educational status, though, bisexual men rarely differed from heterosexual men; after including psychological distress, gay men rarely differed from heterosexual men. Versus heterosexual women, lesbian (adjusted odds ratio [AOR] = 2.33, 95% confidence interval [95% CI] = 1.47–2.30) and bisexual (AOR= 1.78, 95% CI = 1.27–2.50) young adult women had higher rates of prescription opioid misuse, after adjusting for educational status, psychological distress and sociodemographics. Versus heterosexual men, benzodiazepine PDM was elevated in gay men (AOR = 1.91, 95% CI= 1.02–3.58). Educational status was generally associated with lower rates of prescription use and PDM, except for stimulant PDM. Conclusions: Screening for psychological distress and PDM is needed in sexual identity minority young adults, especially for prescription opioid misuse among sexual identity minority women. Culturally-sensitive intervention should be considered for those with elevated psychological distress or signs of PDM. Further research on the sex differences found in the link between psychological distress and sexual identity minority opioid and stimulant PDM is warranted.

Keywords:

• Education
• prescription misuse
• sexual identity
• substance use
• young adults

Additional information

Funding

This work was funded by [R01 DA043696, R01 DA043691, R01 DA042146, R01 AA025684, R01 CA203809, R01 CA212517, R01 DA036541 and R01 DA031160] from the National Institute on Drug Abuse (NIDA), National Cancer Institute (NCI) and National Institute on Alcohol Abuse and Alcoholism (NIAAA). The NSDUH is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). The content is the authors’ responsibility and does not necessarily represent the views of NIDA, SAMHSA, NCI or NIAAA. NIDA, SAMHSA, NCI or NIAAA had no role in the design of the study, the analyses, interpretation of results or the decision to submit the manuscript for publication.